Sandra N Stapel1, Ruben J de Boer2, Patrick J Thoral2, Marc G Vervloet3, Armand R J Girbes2, Heleen M Oudemans-van Straaten2. 1. Department of Adult Intensive Care Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands, s.stapel@vumc.nl. 2. Department of Adult Intensive Care Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands. 3. Department of Nephrology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.
Abstract
BACKGROUND/ OBJECTIVES: During continuous venovenous hemofiltration (CVVH), there is unwanted loss of amino acids (AA) in the ultrafiltrate (UF). Solutes may also be removed by adsorption to the filter membrane. The aim was to quantify the total loss of AA via the CVVH circuit using a high-flux polysulfone membrane and to differentiate between the loss by ultrafiltration and adsorption. METHODS: Prospective observational study in ten critically ill patients, receiving predilution CVVH with a new filter, blood flow 180 mL/min, and predilution flow 2,400 mL/h. Arterial blood, postfilter blood, and UF samples were taken at baseline, and 1, 8, and 24-h after CVVH initiation, to determine AA concentrations and hematocrit. Mass transfer calculations were used to determine AA loss in the filter and by UF, and the difference between these 2. RESULTS: The median AA loss in the filter was 10.4 g/day, the median AA loss by UF was 13.4 g/day, and the median difference was -2.9 g/day (IQR -5.9 to -1.4 g/day). For the individual AA, the difference ranged from -1 g/day to +0.4 g/day, suggesting that some AA were consumed or adsorbed and others were generated. AA losses did not significantly change over the 24-h study period. CONCLUSION: During CVVH with a modern polysulfone membrane, the estimated AA loss was 13.4 g/day, which corresponds to a loss of about 11.2 g of protein per day. Adsorption did not play a major role. However, individual AA behaved differently, suggesting complex interactions and processes at the filter membrane or peripheral AA production. The Author(s). Published by S. Karger AG, Basel.
BACKGROUND/ OBJECTIVES: During continuous venovenous hemofiltration (CVVH), there is unwanted loss of amino acids (AA) in the ultrafiltrate (UF). Solutes may also be removed by adsorption to the filter membrane. The aim was to quantify the total loss of AA via the CVVH circuit using a high-flux polysulfone membrane and to differentiate between the loss by ultrafiltration and adsorption. METHODS: Prospective observational study in ten critically ill patients, receiving predilution CVVH with a new filter, blood flow 180 mL/min, and predilution flow 2,400 mL/h. Arterial blood, postfilter blood, and UF samples were taken at baseline, and 1, 8, and 24-h after CVVH initiation, to determine AA concentrations and hematocrit. Mass transfer calculations were used to determine AA loss in the filter and by UF, and the difference between these 2. RESULTS: The median AA loss in the filter was 10.4 g/day, the median AA loss by UF was 13.4 g/day, and the median difference was -2.9 g/day (IQR -5.9 to -1.4 g/day). For the individual AA, the difference ranged from -1 g/day to +0.4 g/day, suggesting that some AA were consumed or adsorbed and others were generated. AA losses did not significantly change over the 24-h study period. CONCLUSION: During CVVH with a modern polysulfone membrane, the estimated AA loss was 13.4 g/day, which corresponds to a loss of about 11.2 g of protein per day. Adsorption did not play a major role. However, individual AA behaved differently, suggesting complex interactions and processes at the filter membrane or peripheral AA production. The Author(s). Published by S. Karger AG, Basel.
Authors: Mechteld A R Vermeulen; Mireille F M van Stijn; Marlieke Visser; Stéphanie M P Lemmens; Alexander P J Houdijk; Paul A M van Leeuwen; Heleen M Oudemans-van Straaten Journal: JPEN J Parenter Enteral Nutr Date: 2015-01-13 Impact factor: 4.016
Authors: D C Frankenfield; M M Badellino; H N Reynolds; C E Wiles; J H Siegel; S Goodarzi Journal: JPEN J Parenter Enteral Nutr Date: 1993 Nov-Dec Impact factor: 4.016
Authors: Pierre Singer; Annika Reintam Blaser; Mette M Berger; Waleed Alhazzani; Philip C Calder; Michael P Casaer; Michael Hiesmayr; Konstantin Mayer; Juan Carlos Montejo; Claude Pichard; Jean-Charles Preiser; Arthur R H van Zanten; Simon Oczkowski; Wojciech Szczeklik; Stephan C Bischoff Journal: Clin Nutr Date: 2018-09-29 Impact factor: 7.324
Authors: Mette M Berger; Marcus Broman; Lui Forni; Marlies Ostermann; Elisabeth De Waele; Paul E Wischmeyer Journal: Curr Opin Crit Care Date: 2021-08-01 Impact factor: 3.359