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CVVHD treatment with CARPEDIEM: small solute clearance at different blood and dialysate flows with three different surface area filter configurations

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Abstract

Background

The CARdiorenal PEDIatric EMergency (CARPEDIEM) machine was originally designed to perform only continuous venovenous hemofiltration (CVVH) in neonatal and pediatric patients. In some cases, adequate convective clearance may not be reached because of a limited blood flow. In such conditions, the application of diffusive clearance [continuous venovenous hemodialysis (CVVHD)] would help optimize blood purification. In this study, the CARPEDIEM™ machine was modified to enable the circulation of dialysis through the filter allowing testing of the performance of CARPEDIEM™ machine in CVVHD.

Methods

Three different polyethersulfone hemodialyzers (surface area = 0.1 m2, 0.2 m2, and 0.35 m2, respectively) were tested in vitro with a scheduled combination of plasma flow rates (Qp = 10-20-30 ml/min) and dialysis fluid flow rate (Qd = 5-10-15 ml/min). Three sessions were performed in co-current and one in counter-current configuration (as control) for each filter size. Clearance was measured from the blood and dialysate sides and results with mass balance error greater than 5 % were discarded.

Results

Urea and creatinine clearances for each plasma/dialysate combination are reported: clearance increase progressively for every filter proportionally to plasma flow rates. Similarly, clearances increase progressively with dialysate flow rates at a given plasma flow. The clearance curve tends to present a steep increase for small increases in plasma flow in the range below 10 ml/min, while the curve tends to plateau for values averaging 30 ml/min. As expected, the plateau is reached earlier with the smaller filter showing the effect of membrane surface-area limitation. At every plasma flow, the effect of dialysate flow increase is evident and well defined, showing that saturation of effluent was not achieved completely in any of the experimental conditions explored. No differences (p > 0.05 for all values) were obtained in experiments using whole blood instead of plasma or using co-current versus counter-current dialysate flow configuration.

Conclusions

Although plasma flow and filter surface give an important contribution to the level of clearance urea and creatinine, it appears evident that dialysate flow plays an essential role in the blood purification process, justifying the use of CVVHD versus CVVH in case of high dialysis dose requirement and/or limited blood flow rate.

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Acknowledgments

The authors would like to thank the non-profit organization A.A.R.VI for providing support for laboratory measurements and plasma procurement.

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    Authors and Affiliations

    1. International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy

      Anna Lorenzin, Francesco Garzotto, Mauro Neri, Dario Galeano & Claudio Ronco

    2. Department of Immunology and Blood Transfusions, San Bortolo Hospital, Vicenza, Italy

      Alberta Alghisi & Claudio Ronco

    3. Nephrology, Dialysis and Transplantation “G. Brotzu” Hospital, Cagliari, Italy

      Stefania Aresu, Antonello Pani & Claudio Ronco

    4. Nephrology, Dialysis and Transplant Unit, Department of Woman’s and Child’s Health, Hospital and University of Padova, Padova, Italy

      Enrico Vidal, Luisa Murer & Claudio Ronco

    5. Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

      Zaccaroa Ricci & Claudio Ronco

    6. Center for Acute Care Nephrology, Cincinnati Children’s Hospital, Cincinnati, OH, USA

      Stuart L. Goldstein

    7. Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy

      Claudio Ronco

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    1. Anna Lorenzin
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    2. Francesco Garzotto
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    11. Stuart L. Goldstein
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    Corresponding author

    Correspondence to Stuart L. Goldstein.

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    Anna Lorenzin and Francesco Garzotto contributed equally to this work.

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    Lorenzin, A., Garzotto, F., Alghisi, A. et al. CVVHD treatment with CARPEDIEM: small solute clearance at different blood and dialysate flows with three different surface area filter configurations. Pediatr Nephrol 31, 1659–1665 (2016). https://doi.org/10.1007/s00467-016-3397-2

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    • DOI: https://doi.org/10.1007/s00467-016-3397-2

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