title: Dialyzer fiber bundle volume and kinetics of solute removal in continuous venovenous hemodialysis.
abstract: The relationship between dialyzer fiber bundle volume (FBV), dialyzer life span, and small-solute clearance has yet to be clearly defined in continuous venovenous hemodialysis (CVVHD). This study sought to define this relationship using novel ultrasound dilution technology. We studied 55 sessions in 31 intensive care unit patients on CVVHD therapy. A session was defined as the life span of a single dialyzer. The following variables were assessed every 6 hours throughout each session, starting within 1 hour of initiation of that session: FBV, access recirculation, extracorporeal blood flow rate, effluent (EUN) to blood urea nitrogen (BUN) concentration ratio, effluent creatinine to blood creatinine concentration ratio, and urea nitrogen and creatinine clearances. Data were analyzed using random-effects linear models to estimate trends. Several dialysis-related and solute-removal parameters were analyzed for association with each other. Systemic or dialysis circuit heparin was administered in 28 of 55 sessions. One hundred seventy sets of FBV, 101 sets of urea clearance, and 102 sets of creatinine clearance measurements were performed. There was a declining trend for FBV (0.8 mL/h), heart rate (0.25 beats/min/h), and measured blood flow (0.33 mL/min/h; P < 0.05). Apart from dialysate inflow rate (P = 0.044), there was no significant correlation with EUN-BUN ratio. Session duration was associated with dialysis access site; the femoral access provided longer dialysis sessions than subclavian and internal jugular accesses (P = 0.029). We conclude that small-solute removal remains stable over the course of our CVVHD system life spans despite significant loss of hemodialyzer FBV.
authors.affiliation: Department of Nephrology/Hypertension, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Orfeas
authors.initials: O
authors.lastname: Liangos
authors.forename: Paul G
authors.initials: PG
authors.lastname: Sakiewicz
authors.forename: Nigel S
authors.initials: NS
authors.lastname: Kanagasundaram
authors.forename: Jeff
authors.initials: J
authors.lastname: Hammel
authors.forename: Mehdi
authors.initials: M
authors.lastname: Pajouh
authors.forename: Tracy
authors.initials: T
authors.lastname: Seifert
authors.forename: Emil P
authors.initials: EP
authors.lastname: Paganini
mesh_terms: D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood / Q000378:metabolism; D015312:Hemodialysis Solutions / Q000032:analysis / Q000378:metabolism; D006440:Hemofiltration / Q000295:instrumentation* / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D007700:Kinetics; D008657:Metabolic Clearance Rate / Q000502:physiology; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D009584:Nitrogen / Q000378:metabolism; D012079:Renal Circulation / Q000502:physiology; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation; D014508:Urea / Q000378:metabolism
chemical_list: D015312:Hemodialysis Solutions; D014508:Urea; D003404:Creatinine; D009584:Nitrogen