19 April 2000
Acute renal failure, Continuous renal replacement therapy, Continuous arteriovenous hemodiafiltration, Hollow-fiber hemofilters, Polyamide, Polyacrylonitrile, Acrylonitrile sodium methallylsulfonate, Urea clearance
Low dialysate to blood flow rate ratios are a unique characteristic of continuous arteriovenous hemodiafiltration (CAVHDF) that should allow complete saturation of dialysis fluid with small-molecular-weight blood solutes. The aim of the investigation was to evaluate the performance of different hemofilters in CAVHDF. In 10 critically ill patients with acute renal failure, the efficiency of four hollow-fiber hemofilters, polyamide 0.6 m<sup>2</sup>, polyacrylonitrile (PAN) 0.3 and 0.6 m<sup>2</sup>, acrylonitrile sodium methallylsulfonate (AN69HF) 0.6 m<sup>2</sup>, has been evaluated. For comparison, dialysate flow rates (Q<sub>di</sub>) were standardized to 16.6 and 25 ml/min. Samples for urea nitrogen were obtained from the arterial blood line (C<sub>bi</sub>) and from the dialysate exit port (C<sub>do</sub>) within 24-hour running time. Outflowing dialysate (Q<sub>do</sub>) was also measured at the same time. Blood flow (Q<sub>b</sub>) was calculated by the bubble transit time technique. Diffusive and total urea clearances were determined. AN69HF and PAN hemofilters provided higher clearances than the polyamide hemofilter. Despite the smaller surface area, PAN 0.3 m<sup>2</sup> had a total urea clearance comparable to that of PAN 0.6 m<sup>2</sup> and AN69HF at Q<sub>di</sub> = 16.6 ml/min. While at Q<sub>di</sub> = 16.6 ml/min equilibrium between blood and dialysate (C<sub>do</sub>/C<sub>bi</sub> ≅ 1) occurred with the AN69HF and PAN hemofilters, at Q<sub>di</sub> = 25 ml/min the equilibrium was obtained only with the AN69HF hemofilter. In conclusion, almost complete urea saturation of dialysis fluid has not been obtained with all hemofilters tested here. In our experience, membrane characteristics play an important role in determining diffusive efficiency in CAVHDF.