Effects of different dilution methods of replacement fluid on the lifespan of cardiopulmonary bypass and the clearance rate of small molecules in continuous renal replacement therapy without anticoagulation_West China Medical Journal

Authors：

ZHANG Min , WANG Fang , SUN Xiankun , LI Yang , ZHOU Shengyu , LI Xu ,  CHEN Zhiwen

Department of Nephrology, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CHEN Zhiwen, Email: kiyuhot@163.com

Keywords：

Continuous renal replacement therapy; filter life; pre-dilution; post-dilution; pre- and post-dilution

DOI：

10.7507/1002-0179.202205158

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effect of different dilution methods of replacement fluid on cardiopulmonary bypass lifespan and small molecule clearance rate in continuous renal replacement therapy (CRRT) without anticoagulation. Methods Patients who needed to undergo CRRT in West China Hospital of Sichuan University between December 2019 and June 2020 were selected in this prospective cohort study. Continuous veno-venous hemodiafiltration treatment mode was applied, with three different dilution methods, namely pre-dilution, post-dilution, and pre- and post-dilution. The lifespan of cardiopulmonary bypass was recorded, and blood samples were taken to detect creatinine, blood urea nitrogen, etc. Only the lifespan of the first tube of each patient was included. Results A total of 74 patients and pipelines were included, including 18 pre-dilution cases, 34 pre- and post-dilution cases, and 22 post-dilution cases. There was no significant difference in the baseline gender, age, catheterization method, or coagulation function among the three groups of patients (P>0.05). The service life of the circulation pipeline was (32.67±17.42) h in the pre-dilution group and (30.32±16.77) h in the post-dilution group, respectively, and the difference was not statistically significant (P<0.05); the service life of the circulation pipeline was (44.15±21.48) h in the pre- and post-dilution group, which was statistically different from those in the other two groups (P<0.05). There was no statistically significant difference in the decrease of blood urea nitrogen or serum creatinine among the three groups when treated with the three different dilution methods (P>0.05). Conclusion On the premise of not affecting the clearance rate of small molecules, compared with pre-dilution and post-dilution, pre- and post-dilution can prolong the service life of extracorporeal circulation pipelines and filters, and has certain promotion value in clinical practice.

Citation： ZHANG Min, WANG Fang, SUN Xiankun, LI Yang, ZHOU Shengyu, LI Xu, CHEN Zhiwen. Effects of different dilution methods of replacement fluid on the lifespan of cardiopulmonary bypass and the clearance rate of small molecules in continuous renal replacement therapy without anticoagulation. West China Medical Journal, 2022, 37(11): 1686-1689. doi: 10.7507/1002-0179.202205158 Copy

1.	Legrand M, Tolwani A. Anticoagulation strategies in continuous renal replacement therapy. Semin Dial, 2021, 34(6): 416-422.
2.	Brandenburger T, Dimski T, Slowinski T, et al. Renal replacement therapy and anticoagulation. Best Pract Res Clin Anaesthesiol, 2017, 31(3): 387-401.
3.	Nagarik AP, Soni SS, Adikey GK, et al. Comparative study of anticoagulation versus saline flushes in continuous renal replacement therapy. Saudi J Kidney Dis Transpl, 2010, 21(3): 478-483.
4.	Karkar A, Ronco C. Prescription of CRRT: a pathway to optimize therapy. Ann Intensive Care, 2020, 10(1): 32.
5.	Brain M, Winson E, Roodenburg O, et al. Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis. BMC Nephrol, 2017, 18(1): 69.
6.	Alvarez G, Chrusch C, Hulme T, et al. Renal replacement therapy: a practical update. Can J Anaesth, 2019, 66(5): 593-604.
7.	Davies HT, Leslie G, Pereira SM, et al. A randomized comparative crossover study to assess the affect on circuit life of varying pre-dilution volume associated with CVVH and CVVHDF. Int J Artif Organs, 2008, 31(3): 221-227.
8.	张敏, 段棣飞, 张凌, 等. 2 种不同稀释方式在连续性静脉-静脉血液透析滤过治疗中应用效果分析. 中国血液净化, 2019, 18(12): 822-825.
9.	Uchino S, Fealy N, Baldwin I, et al. Pre-dilution vs. post-dilution during continuous veno-venous hemofiltration: impact on filter life and azotemic control. Nephron Clin Pract, 2003, 94(4): c94-98.
10.	Tsujimoto Y, Miki S, Shimada H, et al. Non-pharmacological interventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy. Cochrane Database Syst Rev, 2021, 9(9): CD013330.
11.	Honore PM, Spapen HD. Evolution of vascular access and anticoagulation. Contrib Nephrol, 2018, 194: 15-24.
12.	李克佳, 付月亿, 王欢, 等. 连续性肾脏替代治疗体外循环凝血的影响因素及预防对策研究进展. 中国血液净化, 2018, 17(2): 129-132.
13.	van der Voort PH, Gerritsen RT, Kuiper MA, et al. Filter run time in CVVH: pre- versus post-dilution and nadroparin versus regional heparin-protamine anticoagulation. Blood Purif, 2005, 23(3): 175-180.
14.	杨从山, 杨毅, 黄力维, 等. 重症医学科连续性肾脏替代治疗应用现况调查分析. 中华医学杂志, 2016, 96(39): 3151-3155.
15.	郭晋平, 胡振杰, 李春学, 等. 不同前后稀释比例连续性静-静脉血液滤过对白细胞介素 8 清除效率及滤器寿命影响的比较研究. 中国危重病急救医学, 2011, 23(3): 189-190.
16.	谢长江, 刘卫江, 熊旭明. 两种稀释模式肾脏替代治疗 MODS 患者的效果比较. 中华急诊医学杂志, 2011, 20(7): 734-737.
17.	Koh KH. Impact of pre-dilution and flushing on continuous renal replacement therapy. Singapore Med J, 2006, 47(9): 785-795.

1. Legrand M, Tolwani A. Anticoagulation strategies in continuous renal replacement therapy. Semin Dial, 2021, 34(6): 416-422.
2. Brandenburger T, Dimski T, Slowinski T, et al. Renal replacement therapy and anticoagulation. Best Pract Res Clin Anaesthesiol, 2017, 31(3): 387-401.
3. Nagarik AP, Soni SS, Adikey GK, et al. Comparative study of anticoagulation versus saline flushes in continuous renal replacement therapy. Saudi J Kidney Dis Transpl, 2010, 21(3): 478-483.
4. Karkar A, Ronco C. Prescription of CRRT: a pathway to optimize therapy. Ann Intensive Care, 2020, 10(1): 32.
5. Brain M, Winson E, Roodenburg O, et al. Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis. BMC Nephrol, 2017, 18(1): 69.
6. Alvarez G, Chrusch C, Hulme T, et al. Renal replacement therapy: a practical update. Can J Anaesth, 2019, 66(5): 593-604.
7. Davies HT, Leslie G, Pereira SM, et al. A randomized comparative crossover study to assess the affect on circuit life of varying pre-dilution volume associated with CVVH and CVVHDF. Int J Artif Organs, 2008, 31(3): 221-227.
8. 张敏, 段棣飞, 张凌, 等. 2 种不同稀释方式在连续性静脉-静脉血液透析滤过治疗中应用效果分析. 中国血液净化, 2019, 18(12): 822-825.
9. Uchino S, Fealy N, Baldwin I, et al. Pre-dilution vs. post-dilution during continuous veno-venous hemofiltration: impact on filter life and azotemic control. Nephron Clin Pract, 2003, 94(4): c94-98.
10. Tsujimoto Y, Miki S, Shimada H, et al. Non-pharmacological interventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy. Cochrane Database Syst Rev, 2021, 9(9): CD013330.
11. Honore PM, Spapen HD. Evolution of vascular access and anticoagulation. Contrib Nephrol, 2018, 194: 15-24.
12. 李克佳, 付月亿, 王欢, 等. 连续性肾脏替代治疗体外循环凝血的影响因素及预防对策研究进展. 中国血液净化, 2018, 17(2): 129-132.
13. van der Voort PH, Gerritsen RT, Kuiper MA, et al. Filter run time in CVVH: pre- versus post-dilution and nadroparin versus regional heparin-protamine anticoagulation. Blood Purif, 2005, 23(3): 175-180.
14. 杨从山, 杨毅, 黄力维, 等. 重症医学科连续性肾脏替代治疗应用现况调查分析. 中华医学杂志, 2016, 96(39): 3151-3155.
15. 郭晋平, 胡振杰, 李春学, 等. 不同前后稀释比例连续性静-静脉血液滤过对白细胞介素 8 清除效率及滤器寿命影响的比较研究. 中国危重病急救医学, 2011, 23(3): 189-190.
16. 谢长江, 刘卫江, 熊旭明. 两种稀释模式肾脏替代治疗 MODS 患者的效果比较. 中华急诊医学杂志, 2011, 20(7): 734-737.
17. Koh KH. Impact of pre-dilution and flushing on continuous renal replacement therapy. Singapore Med J, 2006, 47(9): 785-795.

West China Medical Journal

Effects of different dilution methods of replacement fluid on the lifespan of cardiopulmonary bypass and the clearance rate of small molecules in continuous renal replacement therapy without anticoagulation

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content