CVVHFContinuous Venovenous Hemodiafiltration
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The described procedure is only suitable for CVVHf and cannot be adapted for use with continuous venovenous haemodialysis.
All patients were treated with conventional postdilution CVVHf using a bicarbonate or lactate-based solution prior to receiving a citrate-containing substitution fluid and had a stable acid-base balance (pH 7.38 [+ or -] 0.08).
The above data indicate that a citrate-buffered CVVHf substitution fluid maintains stable acid-base balance and achieves effective anticoagulation in the extracorporeal blood circuit.
Although five of our patients had a total bilirubin above 2 mg/dl (34.2 [micro]mol/l) at the beginning of citrate buffered CVVHf therapy (maximum 5.4 mg/dl (92.3 [micro]mol/l)) we did not see metabolic acidosis or evidence of citrate intoxication (defined as metabolic acidosis with increased anion gap not explained by lactate) in any patient, similar to Mitchell et all (19).
In the only major prospective randomised study comparing different doses of haemofiltration, the authors suggest a minimal clearance of 35 ml/kg/h or 2 1/h (33 ml/min) of post-dilution CVVHf for a patient of 70 kg (12).
We thank Fresenius Medical Care for their support and for delivering the substitution fluid for citrate CVVHf. Part of the data is used in the doctoral thesis of Gediz Taskaya.