Department of Clinical, Social and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, Mich., USA.
Blood Purif. 2011;32(2):82-8. doi: 10.1159/000324191. Epub 2011 Mar 2.
BACKGROUND/AIMS: With advanced anticoagulation, many institutions operate continuous renal replacement therapy (CRRT) circuits longer than manufacturers' recommendations. This extended use may change hemodiafilter performance and clearance properties. However, hemodiafilter performance over time has not been assessed. We investigated solute clearance over time in modeled CRRT.
In vitro continuous hemofiltration (CH) and continuous hemodialysis (CD) were operated for 48 h using AN69 polyacrylonitrile, cellulose triacetate, F70 polysulfone, and Optiflux F160NR polysulfone hemodiafilters with citrated bovine blood. Urea, creatinine, gentamicin, vancomycin, and albumin clearances were assessed in CH (ultrafiltration rates = 1 and 3 l/h). Clearances of urea, creatinine, gentamicin, and albumin, were assessed in CD with dialysate flow rate of 2 l/h.
Solute CH clearances were significantly higher at 3 l/h. Only creatinine and gentamicin clearances were affected by time. Creatinine CD clearance significantly declined at 48 h for all hemodiafilters, especially polysulfone hemodiafilters.
CRRT duration affects solute transmembrane clearance. Clinicians should consider hemodiafilter age when assessing hemodialysis dose or drug clearance.
背景/目的：随着先进的抗凝治疗，许多机构使用连续肾脏替代疗法（CRRT）的时间超过了制造商的建议。这种延长的使用可能会改变血液透析滤过器的性能和清除特性。然而，血液透析滤过器的性能随时间的推移尚未得到评估。我们研究了模型化 CRRT 中溶质清除随时间的变化。
使用含柠檬酸的牛血在体外连续血液滤过（CH）和连续血液透析（CD）中运行 48 小时，使用 AN69 聚丙烯腈、纤维素三醋酸酯、F70 聚砜和 Optiflux F160NR 聚砜血液透析滤过器。在 CH 中评估了尿素、肌酐、庆大霉素、万古霉素和白蛋白的清除率（超滤率为 1 和 3 l/h）。在 CD 中，以 2 l/h 的透析液流速评估了尿素、肌酐、庆大霉素和白蛋白的清除率。
3 l/h 时溶质 CH 清除率显著升高。只有肌酐和庆大霉素的清除率受时间影响。所有血液透析滤过器的肌酐 CD 清除率在 48 小时时显著下降，尤其是聚砜血液透析滤过器。
CRRT 持续时间会影响溶质跨膜清除率。临床医生在评估血液透析剂量或药物清除率时应考虑血液透析滤过器的年龄。
