Ammonia Clearance with Different Continuous Renal Replacement Therapy Techniques in Patients with Liver Failure.

INTRODUCTION: Continuous renal replacement therapy (CRRT) can be used to treat hyperammonaemia. However, no study has assessed the effect of different CRRT techniques on ammonia clearance. METHODS: We compared 3 different CRRT techniques in adult patients with hyperammonaemia, liver failure, and acute kidney injury. We protocolized CRRT to progressively deliver continuous veno-venous haemofiltration (CVVH), haemodialysis (CVVHD) or haemodiafiltration (CVVHDF). Ammonia was simultaneously sampled from the patient's arterial blood and effluent fluid for each technique. We applied accepted equations to calculate clearance. RESULTS: We studied 12 patients with a median age of 47 years (interquartile range [IQR] 25-79). Acute liver failure was present in 4 (25%) and acute-on-chronic liver failure in 8 (75%). There was no significant difference in median ammonia clearance between CRRT technique; CVVH: 27 (IQR 23-32) mL/min versus CVVHD: 21 (IQR 17-28) mL/min versus CVVHDF: 20 (IQR 14-28) mL/min, p = 0.32. Moreover, for all techniques, ammonia clearance was significantly less than urea and creatinine clearance; urea 50 (47-54) mL/min versus creatinine 42 (IQR 38-46) mL/min versus ammonia 25 (IQR 18-29) mL/min, p = 0.0001. CONCLUSION: We found no significant difference in ammonia clearance according to CRRT technique and demonstrated that ammonia clearance is significantly less than urea or creatinine clearance.

Circuit Survival during Continuous Venovenous Hemodialysis versus Continuous Venovenous Hemofiltration.

BACKGROUND: Continuous renal replacement therapy (CRRT) technique may affect circuit lifespan. A shorter circuit life may reduce CRRT efficacy and increase costs. METHODS: In a before-and-after study, we compared circuit median survival time during continuous venovenous hemofiltration (CVVH) versus continuous venovenous hemodialysis (-CVVHD). We performed log-rank mixed effects univariate analysis and Cox mixed effect regression modeling to define predictors of circuit lifespan. RESULTS: We compared 197 -CVVHD and 97 CVVH circuits in 39 patients. There was no overall difference in circuit lifespan. When no anticoagulation was used, median circuit survival time was shorter for CVVH circuits (5 h, 95% CI 3-7 vs. 10 h, 95% CI 8-13, p < 0.01). Moreover, CVVHD, lower platelets levels, and longer activated partial thromboplastin time independently predicted longer circuit median survival time. CONCLUSIONS: CVVHD is associated with longer circuit median survival time than CVVH when no anticoagulation is used and is an independent predictor of circuit survival.

Continuous Renal Replacement Therapy Without Anticoagulation: Top Ten Tips to Prevent Clotting.

Continuous renal replacement therapy (CRRT) is intended to function continuously and is prescribed for this outcome. Anticoagulants may not always be used. Clotting and clogging within the CRRT filter stopping therapy occurs with a variability in the total elapsed time associated. This is commonly known as the circuit or filter "life". It is very useful and important to record this time at the bedside and refer to this as a measure of success and quality. Filter life (i.e., hours) is reported in many reports investigating CRRT but is not well understood or clear for when this is considered inadequate and clinical review strategies should be considered. Failure before 8 h could be associated with inadequate renal support and "therapy". Anticoagulation is the key intervention to prolong filter function; however, the extracorporeal circuit design and set up, access catheter profile and insertion site, CRRT machine settings, and the human interface operating CRRT are always important and the only consideration to prevent failure when no anticoagulation is mandated for CRRT.

Faster Blood Flow Rate Does Not Improve Circuit Life in Continuous Renal Replacement Therapy: A Randomized Controlled Trial.

OBJECTIVES: To determine whether blood flow rate influences circuit life in continuous renal replacement therapy. DESIGN: Prospective randomized controlled trial. SETTING: Single center tertiary level ICU. PATIENTS: Critically ill adults requiring continuous renal replacement therapy. INTERVENTIONS: Patients were randomized to receive one of two blood flow rates: 150 or 250 mL/min. MEASUREMENTS AND MAIN RESULTS: The primary outcome was circuit life measured in hours. Circuit and patient data were collected until each circuit clotted or was ceased electively for nonclotting reasons. Data for clotted circuits are presented as median (interquartile range) and compared using the Mann-Whitney U test. Survival probability for clotted circuits was compared using log-rank test. Circuit clotting data were analyzed for repeated events using hazards ratio. One hundred patients were randomized with 96 completing the study (150 mL/min, n = 49; 250 mL/min, n = 47) using 462 circuits (245 run at 150 mL/min and 217 run at 250 mL/min). Median circuit life for first circuit (clotted) was similar for both groups (150 mL/min: 9.1 hr [5.5-26 hr] vs 10 hr [4.2-17 hr]; p = 0.37). Continuous renal replacement therapy using blood flow rate set at 250 mL/min was not more likely to cause clotting compared with 150 mL/min (hazards ratio, 1.00 [0.60-1.69]; p = 0.68). Gender, body mass index, weight, vascular access type, length, site, and mode of continuous renal replacement therapy or international normalized ratio had no effect on clotting risk. Continuous renal replacement therapy without anticoagulation was more likely to cause clotting compared with use of heparin strategies (hazards ratio, 1.62; p = 0.003). Longer activated partial thromboplastin time (hazards ratio, 0.98; p = 0.002) and decreased platelet count (hazards ratio, 1.19; p = 0.03) were associated with a reduced likelihood of circuit clotting. CONCLUSIONS: There was no difference in circuit life whether using blood flow rates of 250 or 150 mL/min during continuous renal replacement therapy.

Con-Current versus Counter-Current Dialysate Flow during CVVHD. A Comparative Study for Creatinine and Urea Removal.

BACKGROUND: Dialysate fluid connection to the membrane in continuous dialysis may affect solute clearance. Although circuit connections are routinely made counter-current to blood flow in intermittent dialysis, no study has assessed the effect of this dialysate fluid flow direction on removal of small solutes creatinine and urea during treatment using continuous veno-venous haemodialysis (CVVHD). AIMS: To assess if dialysate flow direction during CVVHD affects small solute removal. METHODS: This ethics-approved study recruited a convenience sample of 26 adult ICU patients requiring continuous dialysis to assess urea and creatinine removal for con-current vs. counter-current dialysate flow direction. The circuit was adjusted from continuous veno-venous haemodiafiltration to CVVHD 20 min prior to sampling with no fluid removal. Blood (b) and spent dialysate fluid (f) were taken in both concurrent and counter-current fluid flow at 1 (T1) and 4 (T4) hours with a new treatment. Blood flow was 200 ml/min. Dialysate flow 33 ml/min. Removal of urea and creatinine was expressed as the diafiltrate/plasma concentration ratio: Uf/b and Cf/b respectively. Data lacking normal distribution are presented as median with 25th and 75th interquartile ranges (IQR), otherwise as mean with SD and assessed with the independent t test for paired data. p < 0.5 was considered significant. RESULTS: Fifteen male patients were included with a median (IQR) age of 67 years (52-75), and APACHE x0399;x0399; score 17 (14-19) with all patients meeting RIFLE criteria 'F'. At both times, the counter-current dialysate flow was associated with higher mean (SD) diafiltrate/plasma concentration ratios: T1 0.87 (0.16) vs. 0.77 (0.10), p = 0.006; T2 0.96 (0.16) vs. 0.76 (0.09), p < 0.001 for creatinine and T1 0.98 (0.09) vs. 0.81 (0.09), p < 0.001; T2 0.99 (0.07) vs. 0.82 (0.08), p < 0.001 for urea. CONCLUSION: Counter-current dialysate flow during CVVHD for ICU patients is associated with an approximately 20% increase in removal of small solutes creatinine and urea. Video Journal Club 'Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=441270.

Nasal high-flow oxygen therapy in ICU: A before-and-after study.

BACKGROUND: Non-intubated intensive care patients commonly receive supplemental oxygen by high-flow face mask (HFFM), simple face mask (FM) and nasal prongs (NP) during their ICU admission. However, high-flow nasal prongs (HFNP) offer considerable performance capabilities that may sufficiently meet all their oxygen therapy requirements. STUDY AIMS: To assess the feasibility, safety and cost-effectiveness of introducing a protocol in which HFNP was the primary oxygen delivery device for non-intubated intensive care patients. METHOD: Prospective 4-week before-and-after study (6 months apart) for all adult patients admitted to a 22-bed tertiary ICU in Melbourne, Australia. RESULTS: 117 patients (57 before, 60 after) were included: 86 (73.5%) received mechanical ventilation. Feasibility revealed a significant reduction in HFFM (52.6-0%, p<.001), FM (35.1-8.3%, p=.002) and NP (75.4-36.7%, p<.001) use and an increase in HFNP use (31.6-81.7%, p<.05) during the after period. Following extubation, there was a significant reduction in HFFM use (65.7% vs. 0%, p<.05) and an increase HFNP use (8.6% vs. 87.5%, p<.05). Costing was in favour of the after period with a consumable cost saving per patient (AUD $32.56 vs. $17.62, p<.05). During the after period, more patients were discharged from ICU with HFNP than during the before period (5 vs. 33 patients, p<.05) and fewer patients (5 vs. 14 patients) used three or more oxygen delivery devices. Safety outcomes demonstrated no significant difference in the number of intubations, re-intubations, readmissions or non-invasive ventilation use between the two time periods. CONCLUSIONS: Using HFNP as the primary oxygen delivery method for non-intubated intensive care patients was feasible, appeared safe, and the oxygen device costs were reduced. The findings of our single-centre study support further multi-centre evaluations of HFNP therapy protocols in non-ventilated intensive care patients.

Early mobilization on continuous renal replacement therapy is safe and may improve filter life.

INTRODUCTION: Despite studies demonstrating benefit, patients with femoral vascular catheters placed for continuous renal replacement therapy are frequently restricted from mobilization. No researchers have reported filter pressures during mobilization, and it is unknown whether mobilization is safe or affects filter lifespan. Our objective in this study was to test the safety and feasibility of mobilization in this population. METHODS: A total of 33 patients undergoing continuous renal replacement therapy via femoral, subclavian or internal jugular vascular access catheters at two general medical-surgical intensive care units in Australia were enrolled. Patients underwent one of three levels of mobilization intervention as appropriate: (1) passive bed exercises, (2) sitting on the bed edge or (3) standing and/or marching. Catheter dislodgement, haematoma and bleeding during and following interventions were evaluated. Filter pressure parameters and lifespan (hours), nursing workload and concern were also measured. RESULTS: No episodes of filter occlusion or failure occurred during any of the interventions. No adverse events were detected. The intervention filters lasted longer than the nonintervention filters (regression coefficient = 13.8 (robust 95% confidence interval (CI) = 5.0 to 22.6), P = 0.003). In sensitivity analyses, we found that filter life was longer in patients who had more position changes (regression coefficient = 2.0 (robust 95% CI = 0.6 to 3.5), P = 0.007). The nursing workloads between the intervention shift and the following shift were similar. CONCLUSIONS: Mobilization during renal replacement therapy via a vascular catheter in patients who are critically ill is safe and may increase filter life. These findings have significant implications for the current mobility restrictions imposed on patients with femoral vascular catheters for renal replacement therapy. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12611000733976 (registered 13 July 2011).

A comparison of the Niagara and Medcomp catheters for continuous renal replacement therapy.

PURPOSE: The choice of vascular access catheter may affect filter life during continuous renal replacement therapy (CRRT). In particular, differences in catheter design might affect the incidence of circuit clotting related to catheter malfunction. DESIGN AND SETTING: Sequential controlled study in a tertiary, adult intensive care unit (ICU). AIM: To compare circuit life when CRRT was performed with a Niagara catheter or a Medcomp catheter. PATIENTS AND MEASUREMENTS: We studied 46 patients with acute kidney injury requiring CRRT, all delivered with catheters in the femoral position. We obtained information on age, gender, disease severity score [acute physiology and chronic health evaluation (APACHE II) and APACHE III], filter life, heparin dose per hour, daily systemic hemoglobin concentration, platelet count, international normalized ratio (INR), and activated partial thromboplastin time (APTT) during CRRT. RESULTS: We studied 254 circuits in 46 patients. Of these, 26 patients (140 circuits) used the Niagara catheter and 20 patients (114 circuits) used the Medcomp catheter. Median circuit life in the two groups were 11 h and 7.3 h, respectively (p < 0.01). Patients using Medcomp catheters had a lower platelet count (p = 0.04) and a lower hemoglobin concentration (p = 0.01), but INR (p = 0.16), APTT (p = 0.46), anticoagulant treatment (p = 0.89), and heparin dose per hour (p = 0.24) were similar. After correcting for confounding variables by multivariable linear regression analysis, it was found that the choice of catheter is not an independent predictor of circuit life. On Kaplan-Meier survival analysis, circuit life was not significantly different between the two catheters (p = 0.87). CONCLUSION: The choice of either the Niagara or Medcomp catheter does not appear to be a significant independent determinant of circuit life during CRRT.

Amino acid balance with extended daily diafiltration in acute kidney injury.

BACKGROUND: The impact of hybrid dialysis therapies on amino acid (AA) balance in critically ill patients with acute kidney injury is unknown. METHODS: We examined prospectively the AA balance with extended daily diafiltration (EDDF). RESULTS: We studied 7 patients. AA clearances with EDDF ranged from 21.6 ml/min (tryptophan) to 66.9 ml/min (taurine). AA loss was 4.2 (IQR 1.4-12.3) g/day and 4.5% of daily protein intake for patients on enteral nutrition (EN). Percentage AA loss per hour on EDDF was highest for glutamine (32.1%) and lowest for glutamic acid (0.8%). Blood AA levels correlated with corresponding EDDF losses. Median total nitrogen appearance was 25.0 (IQR 20.6-29.3) g/day for patients on EN. This resulted in a negative nitrogen balance of -10.7 (IQR -16.6 to -1.4) g/day, of which 6.5% was attributable to AA loss. CONCLUSIONS: AA loss with EDDF was limited, but with much individual variability, and contributed to a strongly negative daily nitrogen balance.

Bubble chamber clotting during continuous renal replacement therapy: vertical versus horizontal blood flow entry.

BACKGROUND: The continuous renal replacement therapy (CRRT) bubble trap chamber is a frequent site of clotting. AIMS: To assess clot formation when comparing our standard 'vertical' blood entry chamber (BEC) with a new 'horizontal' BEC. METHODS: Adult ICU patients requiring CRRT were treated with the vertical BEC and then a similar subsequent cohort with the horizontal BEC in continuous veno-venous haemofiltration mode. RESULTS: 40 chambers were assessed for each design. Circuit life was 13.9 ± 9.5 h for the vertical and 17.7 ± 15.9 h for the horizontal BEC (p = 0.33). APTT, however, was higher for the horizontal BEC (55.7 ± 34.7 vs. 37.4 ± 9.0, p < 0.002) and no difference in circuit life was found after multivariable analysis. A clotting score ≥3 was observed in 85% of all chambers. There was no difference in chamber clotting score (vertical 3.6 ± 1.03 vs. horizontal 3.8 ± 1.0, p = 0.5). In addition, no difference was found when scores were divided into two groups using a 'likelihood' to clot analysis (p = 1.0). CONCLUSION: CRRT horizontal BEC were not associated with less clotting compared to our standard vertical BEC.

Circuit start during continuous renal replacement therapy in vasopressor-dependent patients: the impact of a slow blood flow protocol.

BACKGROUND AND AIMS: In vasopressor-dependent patients, we evaluated the impact of a slow blood flow protocol on hypotension when starting continuous renal replacement therapy (CRRT). METHODS: Retrospective observational study in tertiary ICU of a slow blood flow protocol at the start of CRRT circuits. RESULTS: 205 circuits in 52 patients were studied. No significant changes in mean arterial pressure (MAP) and norepinephrine dose were found. Only 16 circuit starts in 13 patients were associated with a decrease in MAP >20%. In 23 filters and 11 patients, norepinephrine dose was >50 µg/min at baseline and also did not change significantly. There were no cardiac arrests or ventricular arrhythmias and CRRT was not discontinued because of hypotension. CONCLUSIONS: Implementation of a CRRT slow blood flow protocol in vasopressor-dependent patients enabled the initiation of CRRT circuits with limited hemodynamic consequences and no cardiac arrest or ventricular arrhythmia.

Insertion side, body position and circuit life during continuous renal replacement therapy with femoral vein access.

INTRODUCTION: Choice of insertion side and patient position during continuous renal replacement therapy (CRRT) with femoral vein vascular access may affect circuit life. We investigated if there is an association between choice of insertion side and body position and its changes and circuit life during CRRT with femoral vein access. METHODS: We studied 50 patients receiving CRRT via femoral vein access with a sequential retrospective study in a tertiary intensive care unit. We defined two groups: patients with right or left femoral vein access. We then obtained information on age, gender, circuit life, total heparin dose, hemoglobin concentration and coagulation variables (platelet count, international normalized ratio, and activated partial thromboplastin time) and percentage of time each patient spent in the supine, left lying, right lying, and sitting position during treatment. RESULTS: We studied 341 circuits in 50 patients. Mean circuit life was 13.9 h. Of these circuits, 251 (73.6%) were treated with right femoral vein access. Mean circuit life in this group was significantly longer compared with left femoral vein access (15.0 ± 14.3 vs. 10.6 ± 7.4; p = 0.019). Percentage spent in a particular position during CRRT was not significantly different between two groups. On multivariable linear regression analysis, mean circuit life was significantly and positively correlated with right vascular access site (p = 0.03) and lower platelet count (p = 0.03), but not with patient position. CONCLUSIONS: Right-sided insertion but not time spent in a particular position significantly affects circuit life during CRRT with femoral vein access.

Use of an electronic clinical experience portal for the education of nurses in a critical care unit.

This paper examines a clinical experience portal (CEP) that was developed for critical care nurses to access on a personal digital assistant (PDA) while undertaking a 12-month postgraduate program. The increasing complexity of care provided to patients in intensive care units (ICU) in Australia and overseas requires that health care practitioners working in this area are competent and highly skilled, to prevent errors and adverse events. The CEP - unlike the traditional approach which is often lacking, antiquated or encompassed in paper records - provides opportunity for collaborative activities to occur between the learner and the teacher in an auditable environment to enhance the quality of the education provided. The CEP provided a method for the nurses to record their competencies and access educational material within the framework of a postgraduate program. The benefits of using the CEP for the education of all healthcare professionals' are also discussed.

Evaluation of a radial artery cannulation training program for intensive care nurses: a descriptive, explorative study.

BACKGROUND: Radial arterial line is required for critically ill patients to provide continuous blood pressure monitoring and arterial blood sampling. A program training experienced ICU nurses to perform radial artery cannulation was introduced in a Melbourne metropolitan ICU to allow early treatment and intervention to be delivered to patients while medical staff attend to more urgent diagnostic care. The aim of this research was to evaluate the effectiveness of the training program for radial artery cannulation in the ICU. METHOD: This descriptive explorative study involving a convenience sample of two groups of ICU nurses (11 and 10 participants) was conducted in a 20-bed multi-discipline adult ICU within this metropolitan hospital. Stage I involved data collection of all radial artery cannulation attempts made by participants for a period of 6 months from the training date. Stage II involved completion of questionnaires by participants to reflect on their experience 6 months post-training. The effectiveness of the training program was evaluated based on the success rates of cannulations, any reports of adverse events and participants' responses to questionnaires. RESULTS: 107 patients underwent a cannulation attempt of which 67 (63%) were successful with no reports of adverse events. Eleven nurses managed to achieve competency with a minimum of two successful cannulations. Sixty-seven percent (14 out of 21) responded to the questionnaire and 93% expressed that they would recommend this course to other colleagues. About half of the respondents stated that the ICU nurses' ability to perform radial artery cannulations may prevent patients from having to wait for long periods when doctors are held up. CONCLUSION: The findings showed that ICU nurses can safely insert radial arterial lines with improvements recommended.

Premature circuit clotting due to likely mechanical failure during continuous renal replacement therapy.

OBJECTIVE: Failure of extracorporeal circuit (EC) function during continuous renal replacement therapy (CRRT) appears most likely due to progressive circuit clotting or, in some cases, most likely due to mechanical problems that affect flow. We aimed to study the incidence of such likely mechanical circuit failure (MCF). DESIGN AND SETTING: Retrospective observational study in an adult ICU of a tertiary hospital. PATIENTS AND MEASUREMENTS: We studied 30 patients treated with CRRT via femoral vein vascular access. We obtained information on age, gender, diagnosis, mode of CRRT, circuit life, and blood chemistry. We defined MCF as 'likely' if there was a reduction of between 60 and 80% in circuit life compared to the previous or following circuit life and 'very likely' if such a reduction was between 81 and 100%. RESULTS: We studied 166 circuits in 30 different patients. Of these 26 were electively disconnected leaving 140 circuits with unplanned cessation of function. Among these circuits, likely MCF affected 10 circuits (7.1%) and very likely MCF affected 9 circuits (6.4%) for a total of 19 (13.6%) circuits. CONCLUSION: Mechanical circuit failure appears to affect approximately 1 in 8 circuits. Prospective studies are needed to understand why MCF occurs.

Clinical nursing for the application of continuous renal replacement therapy in the intensive care unit.

Treatment of critically ill patients with continuous renal replacement therapy (CRRT) requires a set of new skills and knowledge base for the intensive care unit (ICU) nurse. After a decision to treat is made, nurses effectively manage the technique by following a series of steps in sequence. These sequential steps include patient and machine circuit preparation, connection of the extracorporeal circuit (EC) to the patient's vascular access, and nursing management of a treatment in progress. During treatment, nurses prepare fluids, adjust fluid settings to provide fluid balance, prepare electrolyte additives, monitor acid base and electrolyte levels, monitor patient and machine "vital signs," and, when necessary, diagnose circuit clotting and perform a disconnection of the EC from the patient. All of these aspects of CRRT nursing are essential for a successful CRRT nursing policy or protocol. This chapter provides a clinical review for this every day sequence when using CRRT in the ICU setting.

Nursing for renal replacement therapies in the Intensive Care Unit: historical, educational, and protocol review.

Nurses have made a significant contribution to the development and application of dialysis in the 1950s and continuous renal replacement therapies (CRRT) in the Intensive Care Unit (ICU) setting from the 1980s. Any treatment requires patient and machine-circuit preparation, connection of the extracorporeal circuit (EC) to the patient vascular access catheter and regular tasks to maintain a treatment in progress. During treatment, nurses prepare fluids, adjust fluid settings to provide fluid balance, prepare electrolyte additives, monitor acid base and electrolyte levels, monitor patient and machine 'vital signs', and then when necessary diagnose circuit clotting and perform a disconnection of the EC from the patient. All of these aspects of CRRT nursing are essential to a suitable nursing policy or protocol. This paper provides a clinical review for this every day sequence when using CRRT in the ICU setting.

Evaluation of urea and creatinine change during continuous renal replacement therapy: effect of blood flow rate.

OBJECTIVE: To determine if faster blood flow rate (BFR) has an effect on solute maintenance in continuous renal replacement therapy. DESIGN: Prospective randomised controlled trial. SETTING: 24-bed, single centre, tertiary level intensive care unit. PARTICIPANTS: Critically ill adults requiring continuous renal replacement therapy (CRRT). INTERVENTIONS: Patients were randomised to receive one of two BFRs: 150 mL/min or 250 mL/min. MAIN OUTCOME MEASURES: Changes in urea and creatinine concentrations (percentage change from baseline) and delivered treatment for each 12-hour period were used to assess solute maintenance. RESULTS: 100 patients were randomised, with 96 completing the study (49 patients, 150 mL/min; 47 patients, 250 mL/min). There were a total of 854 12-hour periods (421 periods, 150 mL/min; 433 periods, 250 mL/ min). Mean hours of treatment per 12 hours was 6.3 hours (standard deviation [SD], 3.7) in the 150 mL/min group, and 6.7 hours (SD, 3.9) in the 250 mL/min group (P = 0.6). There was no difference between the two BFR groups for change in mean urea concentration (150 mL/min group, -0.06%; SD, 0.015; v 250 mL/min group, -0.07%; SD, 0.01; P = 0.42) or change in mean creatinine concentration (150 mL/min, -0.05%; SD, 0.01; v 250 mL/min, -0.08%; SD, 0.01; P = 0.18). Independent variables associated with a reduced percentage change in mean serum urea and creatinine concentrations were low haemoglobin levels (-0.01%; SD, 0.005; P = 0.002; and 0.01%; SD, 0.005; P = 0.006, respectively) and less hours treated (-0.023%; SD, 0.001; P = 0.000; and -0.02%; SD, 0.002; P = 0.001, respectively). No effect for bodyweight was found. CONCLUSIONS: Faster BFR did not affect solute control in patients receiving CRRT; however, differences in urea and creatinine concentrations were influenced by serum haemoglobin and hours of treatment.