INTRODUCTION Chloride transfers during continuous renal replacement therapy (CRRT) have not been adequately described and may differ based on CRRT technique. We aimed to measure chloride mass transfer (JS,Cl) during CRRT and identify associated determinants. METHODS We performed a two-center, prospective, observational study in France and Australia in ICU patients with CRRT initiated for < 24h. Patients received continuous veno-venous hemofiltration (CVVH) or continuous veno-venous hemodialysis (CVVHD, with citrate-CaCl2 regional anticoagulation). Over a 24h period, plasma and effluent chloride concentrations were measured every 4h to compute chloride mass transfer (JS,Cl, in mmol.min-1) using a modality-specific model, with negative value indicating chloride transfer towards the patient. Secondary outcomes were the identification of CRRT settings associated with JS,Cl (using multivariate mixed effects regression). Results are presented with median [interquartile range]. RESULTS Between February 2021 and August 2022, we enrolled 37 patients (64 [56-71] years, 67% male), for a total of 20 CVVHD and 20 CVVH sessions. Over 24h, plasma chloride concentrations were significantly higher, and JS,Cl significantly lower during CVVHD, compared to CVVH (-0.10 [-0.33-0.15] vs. 0.01 [-0.10-0.13] mmol.min-1, P<0.05). With both modalities, net ultrafiltration (QUFNET) and plasma chloride concentrations were the principal determinants of JS,Cl, with higher QUFNET being associated with an increase in JS,Cl during CVVHD. Also, CVVHD sessions demonstrated a concentration gradient between the plasma and the effluent chamber of -6 [-9- -4] mmol.L-1. Finally, CaCl2 reinjection during CVVHD accounted for 35% [32%-60%] of total JS,Cl in sessions with a negative JS,Cl. CONCLUSION Compared to CVVH, CVVHD with regional citrate anticoagulation was associated with greater chloride mass transfer to the patient and higher plasma chloride concentrations. This was due to high dialysate chloride concentrations and CaCl2 reinjection. This effect could only be controlled by high net ultrafiltration flow rates.

中文翻译：

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与采用全身抗凝的 CVVH 相比，采用 CVVHD 的 CaCl2-柠檬酸盐局部抗凝会导致不必要的氯负荷。


引言 连续肾脏替代治疗 (CRRT) 期间的氯离子转移尚未得到充分描述，并且可能因 CRRT 技术的不同而有所不同。我们的目的是测量 CRRT 期间的氯离子质量传递 (JS,Cl) 并确定相关的决定因素。方法 我们在法国和澳大利亚对接受 CRRT 24 小时 < 的 ICU 患者进行了一项两中心、前瞻性、观察性研究。患者接受连续静脉-静脉血液滤过（CVVH）或连续静脉-静脉血液透析（CVVHD，柠檬酸盐-CaCl2区域抗凝）。在 24 小时内，每 4 小时测量一次血浆和流出物氯化物浓度，以使用特定模式模型计算氯化物质量转移（JS，Cl，以 mmol.min-1 为单位），负值表示氯化物向患者转移。次要结果是确定与 JS、Cl 相关的 CRRT 设置（使用多元混合效应回归）。结果以中位数[四分位数间距]表示。结果 2021 年 2 月至 2022 年 8 月期间，我们招募了 37 名患者（64 [56-71] 岁，67% 男性），总共进行了 20 次 CVVHD 和 20 次 CVVH 疗程。与 CVVH 相比，24 小时内，CVVHD 期间血浆氯化物浓度显着升高，JS、Cl 显着降低（-0.10 [-0.33-0.15] 对比 0.01 [-0.10-0.13] mmol.min-1，P<0。 05）。对于这两种模式，净超滤 (QUFNET) 和血浆氯化物浓度是 JS,Cl 的主要决定因素，较高的 QUFNET 与 CVVHD 期间 JS,Cl 的增加相关。此外，CVVHD 会议显示血浆和流出室之间的浓度梯度为 -6 [-9- -4] mmol.L-1。最后，在 JS,Cl 为负值的疗程中，CVVHD 期间的 CaCl2 重新注射占总 JS,Cl 的 35% [32%-60%]。 结论 与 CVVH 相比，采用局部柠檬酸盐抗凝的 CVVHD 与患者的氯化物质量转移较多和血浆氯化物浓度较高相关。这是由于透析液氯化物浓度高和 CaCl2 回注所致。这种效应只能通过高净超滤流速来控制。