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Experimental and Clinical Evaluation of Predilution and Postdilution Continuous Venovenous Hemofiltration on Clearance Characteristics

Chihara, Shinya; Masuda, Yoshiki; Yamakage, Michiaki

doi: 10.1097/MAT.0000000000000468
Renal/Extracorporeal Blood Treatment

We compared the clearance characteristics of low-to-high molecular weight substances during pre-and postdilution continuous venovenous hemofiltration (CVVH) in experimental and clinical conditions. Experimental circuits for pre- and postdilution CVVH were prepared using a test solution containing creatinine (110 Da), inulin (5,000 Da), interleukin (IL)-8 (8,000 Da), IL-6 (22,000 Da), and tumor necrosis factor (TNF)-α (51,000 Da). Quantity of test solution flow and filtration flow (QF) were set to 150 ml/min and 10, 20, and 35 ml/min, respectively. Clinical CVVH settings were blood flow (QB): 150 ml/min and QF: 35 ml/min. Samples were obtained from pre- and posthemofilters, and clearance of target substances was determined during pre- and postdilution CVVH in experimental and clinical conditions. Clearance changed according to QF during both pre- and postdilution CVVH in the experiment. Clearance of creatinine, inulin (experiment only), and IL-8 during postdilution CVVH was superior to that during predilution CVVH. Few differences were seen in clearance of IL-6 and TNF-α between dilution methods in the experiment and clinical practice. Clearance of IL-8 and IL-6 decreased during postdilution CVVH over 24 hr but did not change during predilution CVVH in clinical practice. Predilution CVVH is useful for stable cytokine clearance in septic patients with acute kidney injury.

From the *Division of Clinical Engineering, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan; Department of Intensive Care Medicine, Sapporo Medical University School of Medicine; and Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.

Submitted for consideration July 2016; accepted for publication in revised form October 2016.

Disclosures: The authors have no conflicts of interest to report.

Correspondence: Shinya Chihara, Division of Clinical Engineering, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan. Email: s.chihara@sapmed.ac.jp.

Copyright © 2017 by the American Society for Artificial Internal Organs