SP464PRELIMINARY Experience with High Volume Plasmapheresis Inpediatric Acute Liver Failure (original) (raw)

2018, Nephrology Dialysis Transplantation

INTRODUCTION AND AIMS: Online hemodiafiltration (OL-HDF) with high convective volumes (CV) has been asociated with improved patient survival. Increasing blood flow (Qb) is probably the best option to achieve higher CV, but the rise in Qb entails a progressive reduction in filtration fraction (FF). The aim of this study was to compare different automatic control systems of substitution rate in postdilution OL-HDF using elevated Qb. METHODS: Three control systems were compared in the same 28 patients with usual Qb > 400 ml/min, according to their usual four-hour dialysis prescription and dialyzer: Ultracontrol-AK200 TM UltraS(Baxter), Ultracontrol-Artis TM (Baxter) and AutoSub Plus-5008CorDiax(FMC). We collected vascular access, monitor Qb, effective Qb, arterial and venous pressures, substitution and ultrafiltration rates and volumes hourly, clearances (K) by ionic dialysance, Kt/V, reduction rates of different molecular weight uremic toxins, viscosity parameters, heparin dose and dialyzer clotting status at the end of OL-HDF session. RESULTS: Table 1 represents the results obtained with the three systems (n 28). Ultracontrol-AK200UltraS had higher FF, substitution and CV, but only significant differences were obtained with FF. Ultracontrol-Artis required higher heparin dose than Ultracontrol-AK200U (p 0.024) with no differences in dialyzer clotting status. Selecting those patients with Qb>450ml/min (n18), Ultracontrol-AK200UltraS obtained higher CV (37.663.7 L) compared with Ultracontrol-Artis (33.964.6 L, p¼0.007) or AutoSub Plus (34.963.3 L, p¼0.018), owing to higher FF (32.962.6 %, 28.963.3 %, 29.662.5 % respectively, p<0.001). There were no differences in Qb, hemoglobin, proteins, albumin or gammaglobulins. Differences in hourly CV and FF were more obvious since second hour of treatment. With Qb>450ml/min, Ultracontrol-AK200UltraS reached better reduction of beta2-microglobulin(B2M) (87.664.2 vs 82.968.1 %, p¼0.035) and cystatin-C (84.663.7 vs 81.963.5 %, p¼0.027) compared with AutoSub Plus, and better reduction in creatinine (81.163.7 vs 74.965.1 %, p<0.001), B2M (87.664.2 vs 84.363.1%, p¼0.007), cystatin-C (84.663.7 vs 80.363.5 %, p<0.001) and prolactin (77.167.5 vs 58.7629 %, p¼0.007) compared with Ultracontrol-Artis. CONCLUSIONS: AK200UltraS Ultracontrol system for automatic substitution control optimizes convective transport in postdilution OL-HDF with the highest blood flows. Each substitution control system offers its benefits in different situations.