ABSTRACTS from 16th International COnference on ... - CRRT Online

<strong>ABSTRACTS</strong> FROM 17 TH INTERNATIONAL CONFERENCE ON CRRT,
SAN DIEGO, FEB 14-17, 2012
represented U-shaped curves. ED
[hazard ratio (HR), 1.534] and LD (HR,
1.654) as compared with ID, age (HR,
1.7), diabetes (HR, 1.329), liver cirrhosis
(HR, 1.596), initial central nervous
system dysfunction (HR 1.319), sepsis
(HR, 1.994), as well as pre-RRT mean
arterial pressure (HR, .986), inotropic
equivalent (HR, 1.8), and APACHE II
scores (HR, 1.61) were identified as
independent predictors for in-hospital
mortality. Further, some factors were
identified as predictors for entering
either ED or LD groups. Conclusion:
Current study found the “U-shaped”
association between timing of RRT
initiation and prognoses, and reminded
physicians of paying more attention to
patients with certain risk factors.
78. The Affect Prescription and
Absorption on Anti-epileptic
Concentrations in Ex Vivo CRRT
Model
Paul J McCarthy, Abiodun Orija, Keith
Scott
LSU Health Sciences Center -
Shreveport, Shreveport, LA, USA,
Banner Health, Phoenix, AZ, USA
Background
Neuroscience ICU’s utilize CRRT for
indications such as AKI, sepsis, drug
intoxications, volume overload,
electrolyte control and ICP control.
Many patients on CRRT require anticonvulsive
medications. How CRRT
prescriptions affect drug concentrations
due to filtration or filter absorption is
unknown. We tested four
anticonvulsants in an ex vivo CRRT
model to see how mode affects clearance
and filter absorption. The sieving
coefficients and filter absorption of these
drugs were measured in two modes.
Although sieving coefficients of many
drugs are reported, the filter behavior by
mode of CRRT and filter interaction is
not largely Methods : Machine Setup
A Prismaflex® System configured in
CVVHDF or CVVH using a
Prismaflex® M15 AN-69 filter was
used. Samples were obtained <strong>from</strong> two
runs; in the first run the blood flow rate
was set at 1 ml/min with a replacement
rate of 2 L/hour and no dialysate
(CVVH). On the second run, the blood
flow rate was 1 ml/min, fluid
replacement at 2 L/hour and dialysate at
1L/hr, thus delivering CVVHDF. Saline
was used as the replacement and
dialysate. Filter absorption and sieving
co-efficient were calculated.
Medication Preparation
A saline/Anti-epileptic mixture was
connected to the access line of the
machine. The return line was connected
to an effluent bag.
Drug Sampling & Drug Concentration
After initiating flow samples were drawn
<strong>from</strong> three sites within the circuit; Prefilter,
Post-filter and the Ultra-filtrate.
Phenobarbital, phenytoin and valproate
concentrations were determined using a
particle enhanced turbidimetric
inhibition immunoassay technique.
The sieving coefficient, filter absorption
and drug clearance were calculated for
each run. Results: Phenytoin,
levetiracetam and phenobarbital had
high sieving coefficients with near
complete drug filtration. Valproate had
significant filter absorption with
absorption of 56% and 37% respectively
in CVVH and CVVHDF modes.
Conclusions: Phenytoin, phenobarbital,
and levetiracetam had low absorption
and high sieving coefficients. Valproate
filter absorption was 56 % in CVVH and
37% in CVVHDF. Anti-convulsive drug
levels should be monitored inn patients
on CRRT. Many of these drugs are
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