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Central Venous Line and Dialysis Catheter Position Affects Drug Clearance during Continuous Renal Replacement Therapy in an Animal Model

Frithiof, Robert*; Bandert, Anna*,†; Larsson, Anders; Lipcsey, Miklos§; Smekal, David*

doi: 10.1097/MAT.0000000000000839
Renal/Extracorporeal Blood Treatment
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In intensive care, drugs are commonly administered through central venous catheters (CVC). These catheters and central venous dialysis catheters (CVDC) are often placed in the same vessel for practical reasons. The aim of this experimental study was to investigate if the position of CVC and CVDC influences the elimination of infused drugs, during continuous renal replacement therapy (CRRT). In a randomized, cross-over model, anesthetized piglets received both a CVC and a CVDC in a jugular vein. Another CVDC was placed in a femoral vein for comparison. After baseline measurements, CRRT was performed in either of the CVDC, each CRRT-period separated by another baseline period. Hypotension was induced by peripherally given sodium nitroprusside. In the CVC, both gentamicin and noradrenaline were administered. Noradrenaline was titrated to reach a target blood pressure. When CRRT was performed using the CVDC in the same vessel as the drugs were infused, the plasma concentration of gentamicin was reduced compared with when the infusion and CVDC were in different vessels (5.66 [standard deviation (SD) ± 1.23] vs. 7.76 [SD ± 2.30] mg/l [p = 0.02]). The noradrenaline infusion rate needed to reach the target blood pressure was more than doubled (0.32 [SD ± 0.16] vs. 0.15 [SD ± 0.08] µg/kg/min [p = 0.006]). This experimental study indicates that the removal of drugs is increased if infusion is in close vicinity of the CVDC, during CRRT.

From the *Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

Centre for Research and Development, Uppsala University/Region Gävleborg, Sweden

Section of Clinical Chemistry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden

§Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University, Uppsala, Sweden.

Submitted for consideration October 2017; accepted for publication in revised form May 2018.

Disclosure: Robert Frithiof has received consulting fees from Matisse Pharmaceuticals (https://www.matisse-pharma.com). The remaining authors declare no competing interest.

Supported by funds from the Swedish Research Council (grant 523-2014-2569) and by Uppsala University Research Fund.

R.F. and A.B. equally contributed to the article and therefore share first authorship.

Correspondence: Anna Bandert, Uppsala University, Akademiska Sjukhuset Ingång 70 (1 tr), S-751 85 Uppsala, Sweden. Email: anna.bandert@surgsci.uu.se.

Copyright © 2019 by the American Society for Artificial Internal Organs