Background/Aims: To determine the impact of replacement fluid infusion site on filter life and azotemic control during continuous veno-venous hemofiltration (CVVH). Methods: Pre-dilution CVVH was conducted from February 2001 to December 2001 and then practice was changed to post-dilution (from January 2002 to July 2002). Filter life was prospectively observed and the following data obtained for each filter: starting date and time, ending date and time, heparin use, heparin dose and protamine use. Daily creatinine, urea, INR, APTT and platelet count were also collected. Results: Forty-eight patients were studied (33 in pre-dilution and 15 in post-dilution) for a total of 309 filters (202 in pre-dilution and 107 in post-dilution). The median filter life was significantly shorter in the post-dilution period (18.0 vs. 13.0 h, p = 0.021). Multivariate linear regression analysis showed that pre-dilution was a significant independent predictor of increased filter life (p = 0.029), together with platelet count (p = 0.0035) and heparin dose (p = 0.046). There was no significant improvement in daily creatinine and/or urea reduction in the post-dilution period (% Δ creatinine: 7.9 vs. 10.2%/day, p = 0.99, urea: 5.4 vs. 9.7%/ day, p = 0.78). Conclusions: Post-dilution was associated with reduced filter life without any beneficial effect on daily changes in urea and creatinine levels. Pre-dilution appears a preferable technical approach to CVVH.

Silvester W, Bellomo R, Cole L: Epidemiology, management, and outcome of severe acute renal failure of critical illness in Australia. Crit Care Med 2001;29:1910–1915.
Ronco C, Zanella M, Brendolan A, et al: Management of severe acute renal failure in critically ill patients: An international survey in 345 centers. Nephrol Dial Transplant 2001;16:230–237.
Schetz M: Anticoagulation in continuous renal replacement therapy. Contrib Nephrol. Basel, Karger, 2001, vol 132, pp 283–303.
Kaplan AA: Predilution versus postdilution for continuous arteriovenous hemofiltration. Trans Am Soc Artif Intern Organs 1985;31:28–32.
David S, Cambi V: Hemofiltration: Predilution versus postdilution. Contrib Nephrol. Basel, Karger, 1992, vol 96, pp 77–85.
Honore PM, Wittebolle X, Lozano A: Evaluation of the predilution technique in reducing the occurrence of bleeding during CRRT in critically ill patients. Efficacy of predilution in reducing the amount of anticoagulation during CVVH (abstract). Crit Care 1997;1(suppl 1):97.
Ronco C, Bellomo R, Homel P, et al: Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: A prospective randomized trial. Lancet 2000;356:26–30.
De Pont AC, Oudemans-van Straaten HM, Roozendaal KJ, et al: Nadroparin versus dalteparin anticoagulation in high-volume, continuous venovenous hemofiltration: A double-blind, randomized, crossover study. Crit Care Med 2000;28:421–425.
Fiaccadori E, Maggiore U, Rotelli C, et al: Continuous haemofiltration in acute renal failure with prostacyclin as the sole anti-haemostatic agent. Intensive Care Med 2002;28:586–593.
Gabutti L, Marene C, Colucci G, et al: Citrate anticoagulation in continuous venovenous hemodiafiltration: A metabolic challenge. Intensive Care Med 2002;28:1419–1425.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE-II: A severity of disease classification system. Crit Care Med 1985;13:818–829.
Le Gall JR, Lemeshow S, Saulnier F: A new simplified acute physiology score (SAPS-II) based on an European/North American multicenter study. JAMA 1993;270:2957–2963.
Ronco C, Bellomo R: Principles of solute clearance during continuous renal replacement therapy; in Ronco C, Bellomo R (eds): Critical Care Nephrology. Dordrecht, Kluwer Academic, 1998, pp 1213–1223.
Uchino S, Fealy N, Baldwin I, et al: Continuous is not continuous: The incidence and impact of circuit ‘down-time’ on uraemic control during continuous veno-venous haemofiltration. Intensive Care Med 2003;29:575–578.
Martin PY, Chevrolet JC, Suter P, et al: Anticoagulation in patients treated by continuous venovenous hemofiltration: A retrospective study. Am J Kidney Dis 1994;24:806–812.
Davenport A: The coagulation system in the critically ill patients with acute renal failure and the effect of an extracorporeal circuit. Am J Kidney Dis 1997;30(suppl 4):20–27.
Baldwin I, Tan HK, Bridge N, Bellomo R: A prospective study of thromboelastography and filter life during continuous veno-venous hemofiltration. Ren Fail 2000;22:297–306.
Baker BA, Adelman MD, Smith PA, Osborn JC: Inability of the activated partial thromboplastin time to predict heparin levels. Time to reassess guidelines for heparin assays. Arch Intern Med 1997;157:2475–2479.
Mehta RL: Anticoagulation for continuous renal replacement therapy; in Ronco C, Bellomo R (eds): Critical Care Nephrology. Dordrecht, Kluwer Academic, 1998, pp 1199–1211.
Van de Wetering J, Wesendorp RG, van der Hoeven JG, Stolk B, Feuth JD, Chang PC: Heparin use in continuous renal replacement procedures: The struggle between filter coagulation and patient hemorrhage. J Am Soc Nephrol 1996;7:145–150.
Leslie GD, Jacobs IG, Clarke GM: Proximally delivered dilute heparin does not improve circuit life in continuous venovenous haemofiltration. Intensive Care Med 1996;22:1261–1264.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.