Effects of different modes of dilution during CVVHDF on the removal of different solutes with different molecular weights / 中华急诊医学杂志

Objective To compare the rates of clearance of different solutes during continuous veno-venous haemodiafiltration (CVVHDF) between pre-dilution and post-dilution.Methods A study in vitro was carried out using model CRRT system with AN69 filter used,which was applied to perform CVVHDF for solutes clearance.The removed amounts of different solutes including potassium ion (K +),creatinine (Cr),vancomycin,insulin,and interleukin-6 (IL-6) were determined in the groups of control (without dilution),pre-dilution and post-dilution during CVVHDF at the same substitution fluid amount.Each group was repeated 4 times (n =4).Results Post-dilution mode increased K +,Cr,vancomycin and insulin clearances significantly.There was no difference in clearance of IL-6 between the pre-and post-dilution groups.In the control group,insulin and IL-6 levels were decreased extremely.Conclusions In general,the rate of clearance using post-dilution of CVVHDF is higher than that using pre-dilution.Among high molecular weight solutes,the difference in clearance is not significant.The control group demonstrates insulin and IL-6 adsorbed by the filter.

Effects of continuous venoveHous hemodiafiltration on organ function and eytokines in dogs with multiple organ dysfunction syndrome / 中华肾脏病杂志

Objective To investigate the effects of continuous vennvenous haemodiafihration(CVVHDF)on major organ fimction and plasma cytokine levels in MODS dogs.Methods Fifteen Beagle dogs were subjected to hemorrhagic shock plus resuscitation and endotoxemia to establish MODS model,then dogs were randomly divided into 2 groups:CVVHDF group(n=8)and MODS group without CVVHDF (n=7).CVVHDF was performed for 12 hours after endotoxin injection in CVVHDF group dogs.Serum ALT,AST,Scr,BUN and blood gas were routinely measured,and plasma TNF-α,IL-6 and IL-10 coneentrations were measured by ELISA at different time points. Results Plasma levels of IL-6 and IL-10 were significantly decreased in the CVVHDF group at 3 h,6 h,9 h and 12 h after endotoxin injection as compared with MODS group (P＜0.01).TNF-α levels were similar in both groups(P＞0.05).IL-6 and TNF-α were detected in the ultrafihrate.The sieving coefficients (SC) for IL-6 and TNF-α were 0.27±0.13 and 0.1±0.1 respectively.IL-10 could not be detected in the ultrafiltrate.In CVVHDF group,function of major organs was improved.The beneficial effect of CVVHDF on the hypotension of MODS dogs was particularly striking at 6 h,9 h,and 12 h alter endotoxin injection(P＜0.01).Mean PaO2 in CVVHDF groups at 3 h,6 h,9 h,and 12 h after endotoxin injection was significantly higher than that in MODS group(P＜0.01). Conclusion CVVHDF effectively removes IL-6 and IL-10from the cireulation,attennates endotoxin-induced hypotension and improves arterial oxygenation in MODS dogs.