• Wenyan Yu, Feng Zhuang, Shuai Ma, Mingli Zhu, and Feng Ding.
• 1 Division of Nephrology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China.
• Int J Artif Organs. 2019 Jul 1; 42 (7): 354-361.

BackgroundSome studies suggest the effluent as a surrogate solute removal indicator in continuous hemodialysis or hemofiltration, but the delivered clearance is frequently smaller than prescribed. This study aims at testing whether the effluent, represented by mL/kg/h, could measure solute clearance and whether increasing effluent increases clearance proportionately in continuous hemodialysis or hemofiltration.MethodsPatients treated with continuous renal replacement therapy for various diagnoses were included. The range of dialysate flow rate or substitution fluid flow rate was 1-5 L/h; solutes in the effluent and in the plasma entering the filter were measured, and the ratio of solutes in the effluent and in the plasma entering the filter and the clearance of blood urea nitrogen, creatinine, phosphate, and β2-microglobulin were calculated.ResultsThe ratio of solutes in the effluent and in the plasma entering the filter showed a decreasing trend with increased dialysate flow rate or substitution fluid flow rate (p < 0.05), but solute clearance showed an increasing trend. The increase in solute clearance was less than expected from the increased effluent (p < 0.01), and actual delivered clearance was always below the corresponding prescribed clearance (p < 0.001).ConclusionWith increasing prescribed clearance of continuous renal replacement therapy, effluent rate overestimated the delivered clearance.

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