In vitro clearance of trace elements via continuous renal replacement therapy.
OBJECTIVE
Trace element loss during continuous renal replacement therapy in patients with acute renal failure has not been quantified sufficiently.


METHODS
Trace element loss was quantified using an in vitro model of continuous venovenous hemofiltration. Bovine blood was used for the experiment, and the plasma was analyzed for its chromium, copper, selenium, manganese, and zinc content. Two different polysulfone hemodiafilters, a low-flux F8 and high-flux F70 were used, and tested at two different ultrafiltrate flow rates of 1 L/hr and 2 L/hr, respectively. Trace element concentrations in the plasma and ultrafiltrate were analyzed using inductively coupled plasma mass spectrometry. The sieving coefficient and clearance of each trace element were calculated and compared between the two hemodiafilters.


METHODS
In vitro bovine model of continuous venovenous hemofiltration.


METHODS
Not applicable.


RESULTS
Mean sieving coefficients of both F8 and F70 hemodiafilters were similar for each trace element. Copper, chromium, manganese, selenium, and zinc all were detected in the ultrafiltrate. Estimated trace element loss using typical trace element blood concentrations and study-derived sieving coefficients suggest that daily losses of selenium are greater than what is replenished with a standard daily trace element supplement in total parenteral nutrition.


CONCLUSIONS
These data suggest that the degree of continuous venovenous hemofiltration clearance chromium, copper, selenium, manganese, and zinc differ between elements and that selenium and copper might need to be replaced with doses that exceed typical supplementation guidelines.
University of California-San Francisco, San Francisco, CA, USA.
Audrey T
AT
Nakamura
Imad F
IF
Btaiche
Deborah A
DA
Pasko
Jinesh C
JC
Jain
Bruce A
BA
Mueller
D058186:Acute Kidney Injury / Q000628:therapy; D000818:Animals; D002417:Cattle; D055598:Chemical Phenomena; D002627:Chemistry, Physical; D002857:Chromium / Q000097:blood / Q000737:chemistry; D003300:Copper / Q000097:blood / Q000737:chemistry; D006440:Hemofiltration / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008345:Manganese / Q000097:blood / Q000737:chemistry; D023421:Models, Animal; D012643:Selenium / Q000097:blood / Q000737:chemistry; D013997:Time Factors; D014131:Trace Elements / Q000032:analysis* / Q000172:deficiency; D015032:Zinc / Q000097:blood / Q000737:chemistry
D014131:Trace Elements; D002857:Chromium; D008345:Manganese; D003300:Copper; D012643:Selenium; D015032:Zinc