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：

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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.	張敏, 段棣飛, 張凌, 等. 2 種不同稀釋方式在連續性靜脈-靜脈血液透析濾過治療中應用效果分析. 中國血液凈化, 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, 付月億, 王歡, 等. 連續性腎臟替代治療體外循環凝血的影響因素及預防對策研究進展. 中國血液凈化, 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.	楊從山, 楊毅, 黃力維, 等. 重癥醫學科連續性腎臟替代治療應用現況調查分析. 中華醫學雜志, 2016, 96(39): 3151-3155.
15.	郭晉平, 胡振杰, 李春學, 等. 不同前后稀釋比例連續性靜-靜脈血液濾過對白細胞介素 8 清除效率及濾器壽命影響的比較研究. 中國危重病急救醫學, 2011, 23(3): 189-190.
16.	謝長江, 劉衛江, 熊旭明. 兩種稀釋模式腎臟替代治療 MODS 患者的效果比較. 中華急診醫學雜志, 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. 張敏, 段棣飛, 張凌, 等. 2 種不同稀釋方式在連續性靜脈-靜脈血液透析濾過治療中應用效果分析. 中國血液凈化, 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, 付月億, 王歡, 等. 連續性腎臟替代治療體外循環凝血的影響因素及預防對策研究進展. 中國血液凈化, 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. 楊從山, 楊毅, 黃力維, 等. 重癥醫學科連續性腎臟替代治療應用現況調查分析. 中華醫學雜志, 2016, 96(39): 3151-3155.
15. 郭晉平, 胡振杰, 李春學, 等. 不同前后稀釋比例連續性靜-靜脈血液濾過對白細胞介素 8 清除效率及濾器壽命影響的比較研究. 中國危重病急救醫學, 2011, 23(3): 189-190.
16. 謝長江, 劉衛江, 熊旭明. 兩種稀釋模式腎臟替代治療 MODS 患者的效果比較. 中華急診醫學雜志, 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

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