Volume 25
Number 3
Jul 2017
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Original articles
A. Dalhuisen, N. Vogtländer, A. Katinakis, H. Steenbergen, S. Kamphuis, P.E. Spronk

Introduction: We aimed to evaluate continuous venovenous
haemofiltration (CVVH) versus continuous venovenous
haemodialysis without filtration (CVVHD) - using citrate as
regional anticoagulation - on solute clearance, nurse workload,
and costs.

Methods: Prospective crossover study in a cohort of ICU
patients with acute kidney injury. We compared urea, creatinine
and β2-microglobulin clearance, filter lifespan and membrane
performance over 72 hours (maximal filter runtime) during
15 CVVH and 15 CVVHD sessions. Anticoagulation was
performed with tri-sodium citrate. Direct costs were calculated
per 72 hours. Values indicate median and [P25-P75].

Results: Thirty filter runs were evaluated in 15 patients (9 male)
with acute kidney injury (age 70 [59-76]). During CVVH, urea
and creatinine clearances (34 [34-36] and 31 [27-33] ml/min)
were comparable with CVVHD (32 [25-33] and 25[20-30] ml/
min, respectively; p=0.117 and p=0.041). The clearance of β2-
microglobulin was higher during CVVH (20 [16-22] ml/min)
than during CVVHD (13 [12-14] ml/min; p=0.006). With a
maximum allowed filter runtime of 72 hours, the filter survival
time was longer during CVVHD (72 [4-73 h]) than during
CVVH (43 [17-66 h]; p=0.004). CVVHD was considered less
time-consuming and more user friendly than CVVH by most
nurses, with less down time moments. Costs per 72 hours
were lower during CVVHD: €1073 [€1072-€1146] than during
CVVH €1427 [1225-1551]; p=0.002, with a cost saving of €354
[€153-€405].

Conclusion: During locoregional citrate anticoagulation,
CVVHD is similarly effective, easier to handle and more costeffective
than standard CVVH.


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