• Nigel Fealy, Leanne Aitken, du Toit Eugene E School of Medical Science, Griffith University, Gold Coast, Australia., Michael Bailey, and Ian Baldwin.
• Department of Intensive Care Medicine, Austin Hospital, Melbourne, Australia. nigel.fealy@austin.org.au.
• Crit Care Resusc. 2018 Mar 1; 20 (1): 41-47.

ObjectiveTo determine if faster blood flow rate (BFR) has an effect on solute maintenance in continuous renal replacement therapy.DesignProspective randomised controlled trial.Setting24-bed, single centre, tertiary level intensive care unit.ParticipantsCritically ill adults requiring continuous renal replacement therapy (CRRT).InterventionsPatients were randomised to receive one of two BFRs: 150 mL/min or 250 mL/min.Main Outcome MeasuresChanges in urea and creatinine concentrations (percentage change from baseline) and delivered treatment for each 12-hour period were used to assess solute maintenance.Results100 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.ConclusionsFaster 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.

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