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Evaluation of Urea and Creatinine change during Continuous Renal Replacement Therapy: Effect of blood flow rate

Fealy, N., Aitken, L. M. ORCID: 0000-0001-5722-9090, du Toit, E., Bailey, M. and Baldwin, I. (2018). Evaluation of Urea and Creatinine change during Continuous Renal Replacement Therapy: Effect of blood flow rate. Critical Care and Resuscitation, 20(1), pp. 41-47.

Abstract

OBJECTIVE: To determine if faster blood flow rate (BFR) has an effect on solute maintenance in continuous renal replacement therapy.

DESIGN: Prospective randomised controlled trial. SETTING: 24-bed, single centre, tertiary level intensive care unit.

PARTICIPANTS: Critically ill adults requiring continuous renal replacement therapy (CRRT).

INTERVENTIONS: Patients were randomised to receive one of two BFRs: 150 mL/min or 250 mL/min.

MAIN OUTCOME MEASURES: Changes in urea and creatinine concentrations (percentage change from baseline) and delivered treatment for each 12-hour period were used to assess solute maintenance.

RESULTS: 100 patients were randomised, with 96 completing the study (49 patients, 150 mL/min; 47 patients, 250 mL/min). There were a total of 854 12-hour periods (421 periods, 150 mL/min; 433 periods, 250 mL/ min). Mean hours of treatment per 12 hours was 6.3 hours (standard deviation [SD], 3.7) in the 150 mL/min group, and 6.7 hours (SD, 3.9) in the 250 mL/min group (P = 0.6). There was no difference between the two BFR groups for change in mean urea concentration (150 mL/min group, –0.06%; SD, 0.015; v 250 mL/min group, –0.07%; SD, 0.01; P = 0.42) or change in mean creatinine concentration (150 mL/min, –0.05%; SD, 0.01; v 250 mL/min, –0.08%; SD, 0.01; P = 0.18). Independent variables associated with a reduced percentage change in mean serum urea and creatinine concentrations were low haemoglobin levels (–0.01%; SD, 0.005; P = 0.002; and 0.01%; SD, 0.005; P = 0.006, respectively) and less hours treated (–0.023%; SD, 0.001; P = 0.000; and –0.02%; SD, 0.002; P = 0.001, respectively). No effect for bodyweight was found.

CONCLUSIONS: Faster BFR did not affect solute control in patients receiving CRRT; however, differences in urea and creatinine concentrations were influenced by serum haemoglobin and hours of treatment.

Publication Type: Article
Additional Information: This is the pblished version of a article published in Critical Care and Resuscitation. Reprinted with permission of College of Intensive Care Medicine of Australia and New Zealand.
Subjects: R Medicine > RD Surgery
R Medicine > RT Nursing
Departments: School of Health Sciences > Nursing
URI: http://openaccess.city.ac.uk/id/eprint/20160
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