In vitro evaluation of intensity of continuous hemodialysis in pediatric acute hepatogenic coma patients

Abstract

【Objective】Focusing on pediatric acute liver failure (ALF) patients weighing 10～15 kg, we evaluated the relationship between clearance (CL), membrane area (MA) per blood flow (QB), and dialysate flow rate (QD) in vitro. 【Material and methods】 We calculated CL and mass balance error (%MBE) in the setting of hemofilters sized 0.3 m² and 0.7 m² (AEF-03, AEF-07), QB (20, 40, 80 mL/min), and QD (20, 40, 80 mL/min). Index substances included urea (UN), creatinine (Cr), inorganic phosphorus (IP), and vitamin B12 (VB12). The experimental system was an aqueous solution system, a continuous hemodialysis single pass circuit. 【Result】 The CL material from the small molecular weight group (UN, Cr, IP) depended on QB and QD but not MA. CL of the middle molecular weight material (VB12) depended on QD and MA with a constant QB. The ％MBE from all the results was under 30%. 【Conclusion】 CL of the small molecular weight material depended on QB and QD rather than MA, but it was observed that CL of the middle molecular material, assumed to be a target material for acute liver failure, increased with MA. In pediatric ALF, patients weighing 10～15 kg, changing the MA from 0.3 m² to 0.7 m² may become advantageous in efficiently removing middle molecular weight materials and the coming out of a hepatic coma.