Filter run time in CVVH: pre- versus post-dilution and nadroparin versus regional heparin-protamine anticoagulation.
OBJECTIVE
To study the effect of different modes of continuous veno-venous haemofiltration (CVVH) on filter run time (FRT).


METHODS
We studied, in two consecutive prospective, randomised and crossover studies, 16 and 15 patients with acute renal failure during critical illness. Study A compared pre- versus post-dilution, and study B compared regional anticoagulation with heparin (pre-filter) and protamine (post-filter) (HP) versus nadroparin (NP) pre-filter. All CVVH sessions were standardised. Analyses were by Wilcoxon rank sum tests.


RESULTS
Study A: During pre-dilution the median FRT was 45.7 vs. 16.1 h in post-dilution CVVH (p = 0.005). The median creatinine clearance during pre-dilution was 33 vs. 45 ml/min in post-dilution (p = 0.001). Study B: During NP, median FRT was 39.5 vs. 12.3 h during HP CVVH (p = 0.045).


CONCLUSIONS
Pre-dilution CVVH results in the greatest FRT but a lower plasma creatinine clearance compared to post-dilution. Regional anticoagulation with heparin-protamine resulted in a significantly shorter FRT compared to systemic NP anticoagulation.
van der Voort
P H J
PH
Department of Intensive Care, Medical Centre Leeuwarden, NR-8901 BR Leeuwarden, The Netherlands. phjvdvoort@chello.nl
Gerritsen
R T
RT
Kuiper
M A
MA
Egbers
P H M
PH
Kingma
W P
WP
Boerma
E C
EC
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D006440:Hemofiltration / Q000379:methods; D006494:Heparin Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D017762:Nadroparin / Q000627:therapeutic use*; D011479:Protamines / Q000627:therapeutic use*
D000925:Anticoagulants; D006494:Heparin Antagonists; D017762:Nadroparin; D011479:Protamines