Continuous venovenous hemodialysis in a neonate model: a two-pump system.
OBJECTIVE
To evaluate the efficiency and tolerance of venovenous hemofiltration, hemodiafiltration, and hemodialysis with a two-pump system in a neonatal animal model of acute renal failure.


METHODS
Prospective trial.


METHODS
Animal laboratory at a large university-affiliated medical center.


METHODS
New Zealand white rabbits, weighing 3325 +/- 380 g.


METHODS
Venovenous hemofiltration, hemodiafiltration, and hemodialysis were performed in anesthetized rabbits with previous bilateral ureteral ligation.


RESULTS
At a blood flow rate of 19 +/- 0.5 mL/min, we determined hematocrit, urea, creatinine, and electrolyte values in blood, at the inlet and outlet of the hemofilter, and in ultrafiltrate at the start and after 15, 30, 60, 90, 120, and 180 mins of hemofiltration (ultrafiltrate flow rate of 1.9 +/- 0.2 mL/min), hemodiafiltration (dialysate plus ultrafiltrate flow rate of 16.9 +/- 0.8 mL/min), and hemodialysis (dialysate flow rate of 15.7 +/- 1.1 mL/min). Arterial blood pressure, heart rate, and body temperature were monitored during the procedures. Urea and creatinine instantaneous clearances were higher with hemodiafiltration (8.0 +/- 0.7 and 6.2 +/- 0.7, respectively, n = 29) and hemodialysis (6.8 +/- 1.1 and 4.8 +/- 0.9, respectively, n = 31) than with hemofiltration (1.8 +/- 0.6 and 1.9 +/- 0.4, respectively, n = 16). Initial and final weights, temperatures, and hematocrit, sodium, and protein blood concentrations of each 180-min procedure were similar.


CONCLUSIONS
Hemodiafiltration had a higher urea removal rate than hemodialysis but the management of hemodiafiltration was more cumbersome and time consuming in the absence of a flow equalizer device. As a result, we recommend continuous venovenous hemodialysis as the therapy of choice.
Jouvet
P
P
Neonatal and Pediatric Intensive Care Unit, Hôpital et Université Necker Enfants Malades, Paris, France.
Colomer
S
S
Jugie
M
M
Meftali
Y
Y
Vassault
A
A
Man
N K
NK
D058186:Acute Kidney Injury / Q000097:blood / Q000628:therapy / Q000652:urine; D000818:Animals; D000831:Animals, Newborn; D001831:Body Temperature; D001835:Body Weight; D003404:Creatinine / Q000378:metabolism*; D004195:Disease Models, Animal; D004867:Equipment Design; D017583:Hemodiafiltration / Q000295:instrumentation / Q000379:methods; D006439:Hemodynamics; D006440:Hemofiltration / Q000295:instrumentation / Q000379:methods; D011817:Rabbits; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D014508:Urea / Q000378:metabolism*; D014511:Uremia / Q000097:blood / Q000628:therapy / Q000652:urine
D014508:Urea; D003404:Creatinine