| Objective: So far, the dose of CRRT absences of uniform standard, andthere is little consensus on the relationship between the dose of CRRT andclinical outcomes of AKI in ICU. The purpose of this study was to comparedifferences in CRRT dose based on same prescribed effluent dose, by directmeasurement of creatinine clearance, that to determine the relationshipbetween prescribed effluent dose, correction dose,delivered dose and actualsolute clear dose. So that to provide a reference for sepsis AKI patients whowill accept CRRT treatment in ICU.Methods:23Critical ill patients with sepsis-induced AKI were enrolledfrom intensive-care unit of Hebei medical university affiliated fourth hospitalbetween January1,2012,and February29,2013. Patients were randomlydivided into two groups, CVVH group with14patients and CVVHDF groupwith nine cases. The two groups of patients with gender, weight, age,APACHE II score, SOFA score, and the level of each solute Concentrationwere not statistically significant (p>0.05). In both groups replacement fluidwas delivered into the extracorporeal circuit before the filter (i.e., predilution).The ratio of dialysate to replacement fluid is1:1in the CVVHDF group. Theeffluent flow prescribed was determined based on the patient’s body weight atthe time of randomization and was40ml per kilogram per hour. Arterial bloodsamples before the filter and effluent were collected at the beginning of theCRRT and each time of off the filter. Levels of Cr in plasma and effluent weremeasured by microetch. Levels of β2-M, interleukin-6and interleukin-8inplasma and effluent were measured by Radioimmunoassay (RIA). Prescribedclearance (Kp)was calculated by the effluent rate from the initial prescription.Prescribed K corrected for predilution （Kpc）was corrected for the effect of pre-dilutional replacement fluid;Delivered clearance （Kd）was calculatedfrom the measured effluent volume over24h, adjusted for the effect ofpredilutional replacement fluid；the actual solute clearance (K) dose wascalculated by direct detection of the solute (creatinine, β2-microglobulin,interleukin-6, interleukin-8solute) concentration in the arterial blood beforethe filter and effluent, and combined with the the measured effluent volumeover24h. The differences of prescribed effluent dose, correctiondose,delivered dose actual solute clear dose were compared.28-day mortality,CRRT treatment days, the number of days on mechanical ventilation, ICUlength of stay, total hospital days were also compared in this paper.Results:1The clearance of small solute (creatinine)The actual solute clear dose, delivered dose and correction doses weresignificantly less than the prescription effluent dose with statisticallysignificant difference (p <0.001) in both CVVH and CVVHDF groups. Whatis more, delivered dose measured are less than the correction dose andprescribed effluent dose with statistical difference(p <0.001) in two groups. Inthe CVVH group, Kp，Kpc and Kd overestimated K by40.3，20.0and12.2%, respectively. In the CVVHDF group is33.3，22.3and15.0%,respectively. Compared with CVVH group, the creatinine clearance rate ofCVVHDF group was higher, and there was a statistically significant (p<0.001).2the acute clearance dose of middle-molecule solute (β2-microglobulin,interleukin-6, interleukin-8)In both CVVH group and CVVHDF group， β2-microglobulin，interleukin-6and interleukin-8were effectively cleared. Whenmiddle-molecule solute is greater than20000D, the clearance effect decreasedsignificantly. Compared to CVVHDF group, CVVH group shows a moreeffective clearance of middle-molecule solute.3The anticoagulant way, filter life, treatment outcome and complicationsAnticoagulant way and filter life of the two different groups show no significant difference (p>0.05). Patients with28-day mortality, CRRTtreatment days, days of mechanical ventilation, ICU length of stay, totalhospital days of the two different groups show no significant difference (p>0.05). Also, the application of the proportion of patients with heparin plateletdecline shows no significant difference (p>0.05). Inflammatory cytokines(IL-6, IL-8) can be cleared in the both groups. There was a statisticallysignificant difference for Kd (p <0.001), but for the28-day mortality, there isno significant difference between in the two groups (p>0.05).Conclusions:1With the same prescribed effluent dose (40ml/kg/h)，prescriptioneffluent dose significantly overestimates actual solute clear dose of smallsolutes in both CVVH and CVVHDF groups.2With the same prescribed effluent dose (40ml/kg/h)，the soluteclearance for different solutes was different in the both groups of CVVH andCVVHDF. CVVHDF was superior to CVVH for small solute clearance(Creatinine) but inferior for middle-molecule solute clearance (β2-micr-oglobulin, interleukin-6, interleukin-8). Therefore, we should choose CVVHwhen clearing the middle-molecule solute.3With the same prescribed effluent dose (40ml/kg/h)，inflammatorycytokines (IL-6, IL-8) can be cleared effectively in the both groups, the28-daymortality was similar between two groups. CVVH could not improve survivalcompare to CVVHDF. |
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