Evaluation of Continuous Renal Replacement Therapy Effluent to Assess Filtration Efficiency of Dialyzers in Renal Failure dogs.
Acute Kidney Injury (AKI) and acute on chronic kidney diseases (AOCKD) occurs as a result of acute damage to hemodynamic filtration or excretory functions of kidney resulting in drastic reduction in GFR leads to accumulation of BUN and creatinine, dysregulation of fluid, acid-base and electrolyte balance (Lamiere et al., 2005; Bloom and Lobato, 2011). Despite advances in management of AKI, mortality rates among human and animal patients remains unacceptably high i.e. upto 50-70 percent (Waiker et al., 2008). Continuous Renal Replacement Therapy (CRRT) as a recently developed blood purification modality, therapy continues until return of renal functions or patient is transitioned to intermittent dialysis, functions similar to IHD where patient blood is divided into thousands of straw like semi permeable membranes in a dialyzer and uses principles of diffusion, convection and adhesion (Acierno, 2011). Indications for CRRT are refractory azotemia (BUN level [greater than or equal to]90mg/dl, creatinine level [greater than or equal to]5 mg/dl), interactable uremia, hyperkalemia, fluid overload, severe metabolic acidosis, pre-operative conditioning for renal transplantation, delayed graft function, graft rejection and acute on CRF (Elliott, 2000). The goal of CRRT is the removal of fluid and metabolic waste products and regulation of electrolytes and acid-base balance. Effluent is the filtered waste collected in a effluent bag during the CRRT procedure. Evaluation of effluent may aid in retrospective analysis of therapeutic adequacy of filter/hemodialyzer/artificial kidney. Present study was conducted at Nephrology Referral unit to assess the filtration efficiency of CRRT dialyzers by evaluating dialysis effluent.
Materials and Methods
Eighteen dogs presented with AKI or acute on Chronic kidney injury during the period of June' 2017 to May' 2018 were considered to study the filtration efficiency of hemodialyzers (AN 69 vs. PAES) by evaluating the hemodialysis effluent. All the dogs were subjected to complete clinical examination, hematobiochemical, imaging studies, coagulation parameters and blood gas analysis. Continuous renal replacement therapy (CVVHDF) was performed with Gambro Prismaflex (a) hemodialysis machine as per the standard protocols. Commercially available dialysis solution (Prismasol BO (b)) was used as a dialysate and replacement fluid to promote the process of diffusion and convection, effluent dose rate was set at 30-40ml/kg/hr. M-60 and M-100 filters contain AN 69 HF hollow fiber (Acrylonitrile and sodium methallyl sulfonate copolymer), with a surface area of 0.6[m.sub.2] (M-60) and 0.9[m.sub.2] (M-100) and HF-20 made up of PAES hollow fiber: Polyarylethersulfone membrane with a 0.2[m.sub.2] was used as a artificial kidney during the procedure in renal failure dogs (Kurtzaman, 1997). Effluent collected form a effluent bag attached to Gambro Prismaflex machine was used to assess the filtration efficiency of AN 69 vs. PAES filters by evaluating the chemical composition of filtrate (effluent urea nitrogen and creatinine).
Results and Discussion
AN 69 dialyzers (M-60 and M-100, AN-69 membrane) were used in 83.33 percent (15/18) and PAES dialyzer (HF-20, PAES membrane) was used in 16.66 percent (3/18) of dogs during Continuous renal replacement therapy (CVVHDF). Chemical composition of filtrate (effluent) and dialysate (Prismasol B0) used in CRRT is summarized in Table 1 and 2 respectively. Urea nitrogen (mg/dl) and creatinine (mg/dl) values observed in AN 69 vs. PAES filters were 125.7 and 8.65 vs. 61.71 and 4.02 respectively. Mineral (Ca and P) and electrolyte (Na, K and Cl) composition showed no significant changes in filtrates obtained from both types of dialyzers, as a dialysate and replacement fluid (Prismasol B0), contains buffers and electrolytes which mimics the normal physiological plasma and extracellular fluid (ECF). Electrolytes, acid-base components in dialysate and replacement solution gets exchanged with solutes in blood and maintains equilibrium, whereas accumulated nitrogenous waste substances in patient blood will be exchanged and filtered through dialyzer further collected in effluent waste. Present study shows filtration capacity (urea nitrogen and creatinine) of AN 69 dialyzers are double than the PAES filters, which could be due to larger surface area proportionate with filtration fraction (Prismaflex).
Effective removal of metabolic nitrogenous waste substances like blood urea nitrogen and creatinine were observed in M-60 and M-100 dialyzer than HF-20 dialyzer, which could be due to surface areas and filtration properties of dialyzers.
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P. Ramesh (1), D. Sumathi, M. Chandrasekar, K.G. Tirumurugaan and Ganne Venkata Sudhakar Rao
Department of Veterinary Clinical Medicine
Madras Veterinary College
Tamil Nadu Veterinary and Animal Science University (TANUVAS)
Chennai-600007 (Tamil Nadu)
(1.) Ph.D. Scholar and Corresponding author. E-mail: firstname.lastname@example.org
a-Brand of Baxier India Pvt Ltd., Gurugram
b-Brand of Prismaflex International, France
Table.1: Chemical composition of hemodialysis filtrate (effluent) obtained during CRRT. Dialyzer Capacity/ Urea Creatinine TP Alb Ca P used Flow Nitrogen mg/dl g/dl g/dl mg/dl mg/dl rate mg/dl M-60 & High flow 125.17 8.65 0.38 0.14 7.38 7.58 M-100 N=15 HF-20 Low flow 61.71 4.02 0.53 0.17 7.10 3.96 N=03 Dialyzer Glucose Na mmol K mmol Cl mmol used mg/dl /L /L /L M-60 & 72.35 138.70 2.89 103.38 M-100 HF-20 65.00 138.70 2.43 105.63 Table 2: Chemical composition of body fluids and CRRT (Prismasol-B0) solution (Davenport, 2001) Plasma ECF Prismasol B0 Sodium 136-145 145 137-144 Potassium 3.5-5.5 5.0 0 Calcium 1.1-1.3 2.0 1.25-2.0 Magnesium 0.8-1.2 2.0 0.25-1.0 Chloride 98-106 110.0 98-112 Bicarbonate 21-28 27.0 27-38 Lactate < 0.1 1.5 2.5-10 Glucose 4.2-6.4 4.0 0-11
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|Title Annotation:||Clinical Article|
|Author:||Ramesh, P.; Sumathi, D.; Chandrasekar, M.; Tirumurugaan, K.G.; Rao, Ganne Venkata Sudhakar|
|Date:||Jul 1, 2018|
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