title: Predilution versus postdilution continuous venovenous hemofiltration: no effect on filter life and azotemic control in critically ill patients on heparin.
abstract: In continuous venovenous hemofiltration (CVVH), the delivery of replacement fluid in pre- or postdilution mode remains the subject of controversy. We compared both modes in terms of filter life, dose, and azotemic control. All patients admitted to the intensive care units of a university hospital between November 2004 and December 2006 receiving CVVH and systemic anticoagulation with heparin were retrospectively studied. Thirty-six patients treated by CVVH in predilution and 27 in postdilution mode were studied, with 132 filters in the former and 111 in the latter. The filter life [median ± interquartile range (IQR)] was 24 ± 38 hours and 29 ± 46 hours (p = 0.58) in the pre- and postdilution modes, respectively. Although the fall in creatinine and urea depended on the dose, 19% greater delivered dose in the post- than predilution mode did not impact on azotemic control. In critically ill, heparinized patients on CVVH, filter life and azotemic control are similar in pre- and postdilution modes and underscore the clinical applicability of the predilution mode.
authors.affiliation: Department of Nephrology, VU University Medical Centre, Amsterdam, The Netherlands. sa.nurmohamed@vumc.nl
authors.forename: Shaikh A
authors.initials: SA
authors.lastname: Nurmohamed
authors.forename: Borefore P
authors.initials: BP
authors.lastname: Jallah
authors.forename: Marc G
authors.initials: MG
authors.lastname: Vervloet
authors.forename: Albertus
authors.initials: A
authors.lastname: Beishuizen
authors.forename: A B Johan
authors.initials: AB
authors.lastname: Groeneveld
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D053099:Azotemia / Q000097:blood / Q000628:therapy*; D003404:Creatinine / Q000097:blood; D016638:Critical Illness / Q000628:therapy*; D006440:Hemofiltration / Q000295:instrumentation / Q000379:methods*; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014508:Urea / Q000097:blood
chemical_list: D000925:Anticoagulants; D014508:Urea; D006493:Heparin; D003404:Creatinine