Introduction
AKI, hemoconcentration, critically ill, acute kidney injury
HEMODYNAMIC INSTABILITY, CRITICALLY ILL, KIDNEY REPLACEMENT
Continuous kidney replacement therapy (CKRT) is used in critically ill patients with severe acute kidney injury (AKI). Because it is associated with less hemodynamic instability than intermittent hemodialysis, CKRT is the most commonly utilized form of kidney replacement therapy in the intensive care unit (ICU) setting [Multiple factors are involved in filter life, including access location, anticoagulation use, and factors related to the patient’s illness [However, while hemoconcentration may not occur to a high degree in pre-filter CVVH, there are still rapid fluid shifts that result in sizeable concentration fluctuations in hematocrit and plasma protein levels over a short period of time within the CKRT circuit, which may predispose to increased clotting. The use of dialysate (diffusive clearance) as opposed to post-filter or pre-filter replacement fluid results in substantially less hemoconcentration and substantially smaller shifts in hematocrit and plasma protein concentrations, respectively. Indeed, existing evidence suggests that filter life may be longer when using diffusive clearance, although direct comparisons to pre-filter CVVH are lacking [The purpose of this study was to examine filter life in patients treated with either pre-filter CVVH or CVVHD, with the hypothesis that filter life would be longer in patients treated with CVVHD due to the lack of either hemoconcentration or rapid concentration shifting across the filter.