Pre-dilution and Post-dilution Replacement Fluid

Created on Sat, 07/11/2015 - 23:57
Last updated on Sat, 04/21/2018 - 06:57

The physical effect of pre-filter and post-filter replacement fluid has been explored in Question 5.1 from the first paper of 2009. 

The strategy of giving the replaceent fluid before the countercurrent filter has several positive and negative implications.  Ronco, Bellomo and Kellum's Critical Care Nephrology (2009) within its cavernous interior contains a chapter (number 249, on page 1370) by Zhongping Huang et al, dedicated solely to the discussion of pre and post dilution. The time-poor candidate would be well advised to steer clear of this chapter, and of this textbook as a whole. In its effect on the trainee, it functionally resembles the Necronomicon. To prevent an epidemic of madness among the CICM exam candidates, I have scraped together some salient points from the abovementioned chapter into a table of comparison.

A Comparison of Pre-dilution and Post-dilution in CRRT
  Pre-dilution Post-dilution
Advantages
Disadvantages

 

References

Zhongping Huang, Jeffrey J. Letteri, Claudio Ronco, Dayong Gao, and William R. Clark "Predilution and Postdilution Reinfusion Techniques"; in: Critical Care Nephrology by Ronco, Bellomo and Kellum (2009) pp. 1370

Ronco, C., et al. "The haemodialysis system: basic mechanisms of water and solute transport in extracorporeal renal replacement therapies." Nephrology Dialysis Transplantation 13.suppl 6 (1998): 3-9.

Uchino, Shigehiko, et al. "Pre-dilution vs. post-dilution during continuous veno-venous hemofiltration: impact on filter life and azotemic control." Nephron Clinical Practice 94.4 (2004): c94-c98.

Nurmohamed, Shaikh A., et al. "Predilution versus postdilution continuous venovenous hemofiltration: no effect on filter life and azotemic control in critically ill patients on heparin." ASAIO Journal 57.1 (2011): 48-52.