The Design And Solute Clearances Of Two Novel Modes Of Continuous Blood Purification

Part OneDesigning two novel modes of continuous blood purificationObjectives:To design two novel modes of continuous blood purification aimed to decrease the loss of small molecular solutes in high volume hemofiltration.Methods:The ultrafiltration fluid of high-flux hemofilter was recycled and went through low-flux hemofilter,then the cascade ultrafiltration fluid which includes small molecular weight solutes entered to the blood and rest fluid was dropped.The mode was named double hemofiltration(DHF).And we developed another new mode called Dialysate-free hemdiafitration(DF-HDF).We tested the pressure of the extracorporeal circuit in these two new modes of continuous blood purification.Results:(l)Two low-flux hemofilters instead of one hemofilter were needed to finish DHF due to high pre-filter pressure.(2).The special nursing was required in DHF because of adverse effects due to interruption of bumps of CRRT machine or of BM11 machine.(3)DF-HDF can advoid the adverse effects due to interruption of bumps of CRRT machine or of BM11 machine.Conclusion:DHF and DF-HDF can rationally decrease the loss of small molecular solutes compared to HVHF and can be carried out in clinic.Part TwoClearance of different solutes by two novel modes of continuous blood purificationObjectives:Decreasing the removal of small soluble solutes by high volume hemofiltration(HVHF)may improve the outcome of critically ill patient receiving continuous renal replacement therapy(CRRT).The study was aimed to measure the capability of clearance of solutes by two novel modes of CRRT.Methods:From September 2013 to Febrary 2014,patients with renal failure receiving extended hemodialysis in Jingling hospital were enrolled to four groups,standard volume hemfiltration(SVHF),HVHF,double hemofiltration(DHF)or dialysate-free hemodiafiltration(DF-HDF).The effulent fluid in four groups were 35ml/Kg/h,100ml/Kg/h,35ml/Kg/h and 30ml/Kg/h,respectively.The specimens of blood and effulent fluid were collected at the first hour after start of blood purification,and the clearances of β2-microglobunlin,cystatin C,ereatinine,phosphorus were calculated Results:This study included 40 patients.The clearance of creatinine by SVHF,HVHF,DHF,DF-HDF were 30.1±2.0 ml/Kg/h,69.0±7.2 ml/Kg/h,31.1±1.5 ml/Kg/h and 31.6±2.5 ml/Kg/h,respectively,and The clearance of creatinine by DHF,DF-HDF were significantly inferior to that of HVHF(P<0.05)and not superior to that of SVHF.The clearance of p2-microglobunlin by SVHF,HVHF,DHF,DF-HDF were 16.1±2.8 ml/Kg/h,35.0±7.5 ml/Kg/h,39.0±6.0 ml/Kg/h and 35.3±10.4 ml/Kg/h,respectively,and The clearance of β2-microglobunlin by DHF,DF-HDF were not inferior to that of HVHF(P<0.05)and were superior to that of SVHF(P<0.05).No severe adverse effects were detected in the treatment.Conclusion:DHF and DF-HDF increase the removal of middle molecular solutes compared to SVHF and decrease the removal of small soluble solutes compared to HVHF.Part ThreeClearance of amino acids by two novel modes of continuous bloodpurificationObjectives:The study was aimed to measure the capability of clearance of amino acids by two novel modes of CRRT.Methods:From September 2013 to February 2014,patients with renal failure receiving extended hemodialysis in Jingling hospital were enrolled to four groups,standard volume hemfiltration(SVHF),HVHF,double hemofiltration(DHF)or dialysate-free hemodiafiltration(DF-HDF).The effulent fluid in four groups were 35 ml/Kg/h,100 ml/Kg/h,35 ml/Kg/h and 30 ml/Kg/h,respectively.The specimens of blood and effulent fluid were collected at the first hour after start of blood purification,and the clearances of 17 aminoacids were calculated.Results:The SCs of aspartate acid and glumatic acid by high-flux hemofilter were 0.5 and 0.7,respectively;and the SCs of other 15 amino acids by AV600 were nearly 0.95.In contrast,the SCs of all 17 amino acids by low-flux hemofilter were nearly 1.0.The clearance of 17 amino acids by SVHF,HVHF,DHF,DF-HDF were 17.1-31.9 ml/Kg/h,56.1-72.1 ml/Kg/h,16.0-32.1 ml/Kg/h and 25.5-38.6 ml/Kg/h,respectively.The clearances of aspartate acid and glumatic acid were lower than the clearances of others amino acids which have similar clearances in four modes of CRRT.The clearances of amino acids except aspartate acid were greater in HVHF than in those in SVHF,DHF and DF-HDF.The clearances of amino acids except aspartate acid in DF-HDF were similar with those in SVHF and DHF.The estimated loss of 17 amino acids by SVHF,HVHF,DHF,DF-HDF were 10.4±3.3 g,20.6±4.5g,11.5±3.5g and 10.4±2.3g,respectively.The estimated losses of amino acids in HVHF were greater than those in SVHF,DHF and DF-HDF.And the estimated losses of amino acids in DHF and DF-HDF were similar with those in SVHF.Conclusions:HVHF increase losses of amino acids than SVHF.DHF and DF-HDF decrease losses of amino acids compared with HVHF,while DHF and DF-HDF have similar capacity of removing middle molecular solutes.