title: Albumin priming does not prolong hemofilter life.
abstract: The hypothesis was tested that prepriming a hemofilter and lines with heparinized human albumin (NSA) instead of heparinized saline (NS) increases filter survival time. In a university affiliated intensive care unit, all patients were eligible who required continuous venovenous hemodiafiltration and who did not have pre-existing coagulopathy or contraindications to heparin. New hemofilters were randomized to priming with 2 liters NS or 1 liter NS followed by 500ml NSA. The prime was recirculated for at least 30 minutes before connection to the patient. Anticoagulation was tightly controlled, aiming for a patient activated partial thromboplastin time (APTT) of 60 seconds. Survival analysis was used to compare filter life. Elective discontinuation (e.g., for surgery) were treated as censored data. A total of 91 hemofilters were used in 40 patients during 9 months: 45 randomized to NS, and 46 to NSA. Of these, 57 hemofilters were used until spontaneous failure, 28 NS and 29 NSA; 34 hemofilters were electively discontinued, 17 in each group. Anticoagulation was identical in both groups; the mean APTT value (+/- SE) was 58.2 seconds (+/- 3.1) for NS and 58.0 seconds (+/- 2.8) for NSA (p > 0.9 unpaired t-test). Platelet counts were very similar at 170 x 10(9) (+/- 21.8) for NS and 181 x 10(9) (+/- 23.7) for NSA (p = 0.74 unpaired t-test). There was no significant difference in the filter life between the two groups. For NS, median filter life was 37.8 hours (range 0.6-120); for NSA, median filter life was 45.4 hours (range 2.5-109; p = 0.998 log rank). The power to detect a 50% improvement in filter life was > 90%. Based on this data, the use of albumin priming as an aid to increased hemofilter life can not be recommended.
authors.affiliation: Department of Intensive Care, St Vincent's Hospital, Fitzroy, Victoria, Australia.
authors.forename: J H
authors.initials: JH
authors.lastname: Reeves
authors.forename: P F
authors.initials: PF
authors.lastname: Seal
authors.forename: A L
authors.initials: AL
authors.lastname: Voss
authors.forename: C
authors.initials: C
authors.lastname: O'Connor
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy; D000925:Anticoagulants / Q000008:administration & dosage; D017583:Hemodiafiltration / Q000295:instrumentation / Q000379:methods*; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007362:Intensive Care Units; D011446:Prospective Studies; D012709:Serum Albumin / Q000008:administration & dosage*; D013997:Time Factors
chemical_list: D000925:Anticoagulants; D012709:Serum Albumin; D006493:Heparin