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PubMed1977

Separation of dialysis and ultrafiltration-does it really help?

Ultrafiltration alone for fluid removal has been used and assessed in a number of clinical studies. A paired study of ultrafiltration alone against haemodialysis has shown that as compared to haemodialysis, ultrafiltration alone within the ultrafiltration rates used is well tolerated. The use of ultrafiltration alone for both acute and chronic fluid overload has been shown to be an ideal therapeutic procedure. In a third study using the Rhodial 75 system and RP6 dialyser in a group of non-fluid-overloaded patients the separation in time of ultrafiltration from haemodialysis has shown no obvious advantages over regular haemodialysis.

Adult↗
PubMed1984

Treatment of critical neonatal edema with hemo-ultrafiltration.

Three neonates with extreme edema associated with cardiovascular and renal insufficiency were treated with hemo-ultrafiltration for removal of critical edema fluid. In each patient peritoneal dialysis had not been effective in expedient fluid removal. Ultrafiltration was accomplished by occlusion of the proximal dialysate portal of a Travenol EX12-11, 0.8 m2 dialyzer and the application of vacuum suction to the distal portal. Blood flow ranged from 10-25 ml/min. The rate of ultrafiltration averaged 0.57 ml/kg/min resulting in losses of 4-16% of body weight. Episodes of hypotension were associated with too rapid ultrafiltration rate and not total volume removed. All patients tolerated the procedure. Two of the three patients demonstrated improvement in blood pressure, oxygenation and urine flow following the ultrafiltration. Ultrafiltration in the newborn may be a useful therapeutic procedure when conventional treatment fails.

Acute Kidney Injury↗
PubMed1983

Determination of ultrafiltrable zinc in plasma by flameless atomic absorption spectrophotometry.

Ultrafiltrable zinc can be determined in small volumes of plasma by using Amicon ultrafiltration membrane cones and either flameless atomic absorption spectrophotometry or 65Zn. The ultrafiltration membrane cone is made sufficiently zinc-free by acid washing, followed by rinsing with de-ionized water. Within-run CVs were 12 and 10%, respectively, for the two methods. Matrix effects are compensated for by using standards in solutions with an inorganic matrix that simulates the sample matrix. Results for ultrafiltrable zinc by the two techniques agreed, and agreed with previously published data obtained by different ultrafiltration techniques. The mean (and SD) percentage of plasma zinc that was ultrafiltrable in 12 control subjects was 1.0 (0.5) by AAS and 0.7 (0.3) by 65Zn.

Humans↗
PubMed1995

[Agents preventing decrease in ultrafiltration in a rat model with peritoneal hyperpermeability].

Ultrafiltration failure has been one of the major causes of drop out from CAPD treatment. The present study was designed to develop an ultrafiltration failure model in the rat and to assess whether various agents could prevent a decrease in ultrafiltration capacity in this rat model. Peritoneal hyperpermeability was induced by repeated intraperitoneal injection of 15 ml of 4.25% dextrose dialysate for 7 days. Some of the rats received agents, such as phosphatidylcholine, chondroitin sulfate, siliac acid, heparan sulfate, keratan sulfate, sodium sulfate, sodium phosphate, and heparin sodium, simultaneously administered with 4.25 % dextrose dialysate for the same duration. Ultrafiltration volume, D4/D0 ratio of glucose and peritoneal net fluid absorption were evaluated by 4-hour dwelling of 30 ml of 2.5% dextrose dialysate. Sodium phosphate and heparan sulfate prevented peritoneal hyperpermeability due to repeated injection of hypertonic dialysate. Sodium phosphate, sodium sulfate, heparin and heparan sulfate suppressed peritoneal net fluid absorption, resulting in an increase in ultrafiltration. These findings may be applicable to CAPD patients with ultrafiltration loss.

Absorption↗
PubMed1994

Calcium balance and serum ionized calcium fluctuations in on-line haemodiafiltration in relation to ultrafiltration rate and dialysate calcium concentration.

The use of high ultrafiltration rates in haemodiafiltration (HDF) has been suggested for improving the clearance of small and large molecules. This strategy has become economically applicable with the development of safe techniques for on-line production of sterile infusate from dialysate, which enables us to infuse large substitution fluid volumes without further increasing the cost of sessions. The effect of increasing the ultrafiltration rate in HDF on electrolyte balance has not yet been evaluated. The aim of this study was to evaluate the effects of variations of the ultrafiltration rate on calcium kinetics in HDF using three different dialysate calcium concentrations. Since the increase in ultrafiltration rate augments the convective calcium loss, variations of intrasession calcium balance could result from modifications of the ultrafiltration rate. In the present study we found no significant variations in calcium balance and serum ionized calcium (iCa) levels during on-line HDF treatment when increasing the mean ultrafiltration rate from 60 to 100 ml/min in the presence of an adequate and corresponding increase in the infusion rate (from 2.5 to 5 l/h). During the balance studies, pretreatment serum iCa was on the average 1.32 mmol/l and weight loss 3.2 kg. Mean calcium loss during treatment was 2.8 and 3.3 mmol at infusion rates of 2.5 and 5 l/h with 1.63 mmol/l of calcium in both the dialysate and infusate; calcium loss rose to 5.9 and 11.2 mmol at infusion rates of 2.5 l/h and to 5.7 and 14.2 mmol at infusion rates of 5 l/h when the dialysate and infusate calcium was reduced respectively to 1.5 and 1.25 mmol/l.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcium↗
PubMed1993

Ultrafiltration failure and dialysate glucose in CAPD.

This study was performed to evaluate the use of the glucose concentration versus glucose absorption in the dialysate to estimate ultrafiltration efficacy. In 26 patients (16 men, 10 women) on continuous ambulatory peritoneal dialysis, a total of 128 dwells were investigated. Each dwell lasted 5 hours, using 2 L of peritoneal dialysis fluid containing 140 mmol/L glucose. After the dwell, the removed peritoneal dialysis fluid was weighted. The concentrations of creatinine and glucose and the total amount of glucose were analyzed. The mean concentration of dialysate glucose for the whole group after a 5-hour dwell was 38.9 +/- 8.9 (SD) mmol/L. The ultrafiltration volume was inversely correlated to the glucose absorbed (r = -0.59, p = 0.002), but was not significantly correlated to the glucose concentration in the dialysate (r = 0.40, p = 0.057). The ultrafiltration volume was not related to the creatinine concentration in the dialysate or the body weight. The average dialysate glucose did not change during a one-year observation time. Patients with diabetes mellitus had significantly lower glucose absorption than nondiabetics (p = 0.045), and patients with low ultrafiltration efficacy had significantly greater glucose absorption than those with normal and high ultrafiltration (p = 0.038). There was no difference between those who had those who had not suffered from peritonitis. The results indicate that the glucose absorption from the dialysis fluid is the best parameter to calculate the peritoneal ultrafiltration efficacy and not the glucose concentration currently used.

Adult↗
PubMed1996

Ultrafiltration after cardiopulmonary bypass in children: effects on hemodynamics, cytokines and complement.

OBJECTIVES: The purpose of the study was to evaluate the clinical and hemodynamic effect of intraoperative extracorporeal ultrafiltration (UF) and its potential in reducing the plasma concentration of circulating cytokines and complement activation products following open heart surgery in children. METHODS: Eighteen children with congenital heart disease were prospectively randomized into a control group (n = 9) and a group who underwent UF (n = 9). Serial plasma samples for measurements of circulating cytokines (interleukin 6 (IL-6), tumor necrosis factor alpha (TNF), and its soluble receptor (sTNF receptor)), and complement factors (C3 activation products (C3a and C3bc) and terminal complement complex (TCC)) were obtained before, during and up to 48 h after cardiopulmonary bypass (CPB). A pulmonary artery thermodilution catheter was introduced preoperatively for hemodynamic monitoring. RESULTS: Postoperative hemodynamics were similar in both groups. Plasma levels of IL-6, sTNF receptors, C3a, C3bc and TCC increased significantly perioperatively (P < 0.01) in both groups. TNF was detected transiently in 16 patients perioperatively and in 4 of the 9 ultrafiltrate samples in concentrations similar to the plasma levels. Complement activating products were not detected in the ultrafiltration samples except for small amounts of C3a in two cases. Compared to the control group the plasma levels of C3a, C3bc and TCC were unaffected by the ultrafiltration procedure. The level of IL-6 and sTNF receptors increased significantly after 15 min of UF but there was no significant difference between the two groups postoperatively. CONCLUSIONS: In this study no clinical or hemodynamic effect was registered after UF. TNF and C3a were occasionally detected in the ultrafiltrate but we were unable to demonstrate reduction of these or any of the other markers tested in the group subjected to ultrafiltration.

Cardiopulmonary Bypass↗
PubMed1997

Modified ultrafiltration after cardiopulmonary bypass in pediatric cardiac surgery.

BACKGROUND: Cardiopulmonary bypass in children results in considerable water retention, especially in neonates and small infants. Dilution of plasma proteins increases water loss into the extravascular compartments. Excessive total body water may prolong ventilatory support and may contribute to a prolongation of intensive care convalescence. After discontinuation of cardiopulmonary bypass, modified ultrafiltration can be used to withdraw plasma water from the total circulating volume. METHODS: This retrospective study included 198 pediatric patients who underwent cardiac operations in the period from September 1991 to November 1994. Two groups were compared: 99 patients without ultrafiltration and 99 patients receiving modified ultrafiltration. The following indices were analyzed: cardiopulmonary bypass prime volume, transfused blood volume during and after the operation, postoperative chest drain loss, and hemoglobin and hematocrit levels before, during, and after the procedure. RESULTS: Modified ultrafiltration resulted in a significant increase in hemoglobin and hematocrit levels and a significantly lower amount of transfused blood. Mean postoperative chest drain loss was significantly less in the patients who underwent modified ultrafiltration. CONCLUSIONS: Modified ultrafiltration decreases blood transfusion requirements and chest drain loss after pediatric cardiac surgical procedures.

Blood Transfusion↗
PubMed1997

Modified ultrafiltration attenuates dilutional coagulopathy in pediatric open heart operations.

BACKGROUND: Extreme hemodilution caused by relatively large prime volumes required for cardiopulmonary bypass in infants causes a dilutional coagulopathy, characterized by low concentrations of fibrinogen and other circulating coagulation factors. Modified ultrafiltration results in hemoconcentration and is associated with decreases in postoperative bleeding and transfusion requirements in children. This study was undertaken to quantify the effect of modified ultrafiltration on concentrations of fibrinogen, plasma proteins, and platelets in infants and small children. METHODS: Twenty patients less than 15 kg were studied. Cardiopulmonary bypass circuits were primed with crystalloid solutions. Red blood cells were added during cardiopulmonary bypass for hematocrits less than 15%. Colloid solutions were not administered. Concentrations of fibrinogen, plasma proteins, and platelets, and hematocrit were measured before cardiopulmonary bypass, before modified ultrafiltration, and after modified ultrafiltration. RESULTS: Modified ultrafiltration was associated with significant (p < 0.001) increases in hematocrit (19% +/- 6% to 31% +/- 9%), fibrinogen (65 +/- 29 to 101 +/- 45 mg/dL), and total plasma proteins (2.7 +/- 0.3 to 4.9 +/- 0.7 g/dL), but no change (p = 0.129) in platelet count. CONCLUSIONS: We conclude that modified ultrafiltration significantly attenuates the dilutional coagulopathy associated with cardiopulmonary bypass in infants.

Blood Coagulation Disorders↗
PubMed1997

Simultaneous rapid high-performance liquid chromatographic determination of phenytoin and its prodrug, fosphenytoin in human plasma and ultrafiltrate.

A reversed-phase high-performance liquid chromatographic assay for the simultaneous determination of phenytoin and fosphenytoin, a prodrug for phenytoin, in human plasma and plasma ultrafiltrate is described. For plasma, the method involves simple extraction of drugs with diethyl ether and evaporation of solvent, followed by injection of the reconstituted sample onto a reversed-phase C18 column. Plasma ultrafiltrate is injected directly into the HPLC column. Compounds are eluted using an ion-pair mobile phase containing 20% acetonitrile. The eluent is monitored by UV absorbance at 210 nm. The fosphenytoin standard curves are linear in the concentration range 0.4 to 400 microg/ml for plasma and 0.03 to 80 microg/ml for ultrafiltrate. Phenytoin standard curves are linear from 0.08 to 40 microg/ml for plasma and from 0.02 to 5.0 microg/ml for ultrafiltrate. No interferences with the assay procedure were found in drug-free blank plasma or plasma ultrafiltrate. Relative standard deviation for replicate plasma or ultrafiltrate samples was less than 5% at concentrations above the limit of quantitation for both within- and between-run calculations.

Anticonvulsants↗
PubMed2000

Hemodiafiltration with online regeneration of the ultrafiltrate.

The concept of regeneration of dialysis fluids and of ultrafiltrate in particular has been recently revisited. Hemodiafiltration with online regeneration of the ultrafiltrate allows the concomitant infusion of sodium, calcium, and bicarbonate. Here, we studied the adsorptive characteristics of an integrated two-step sorbent system relative to different solutes present in the ultrafiltrate: sodium, calcium, phosphate, bicarbonate, uric acid, creatinine, and beta2-microglobulin. In vitro studies were performed in order to differentiate the relative roles for each sorbent (mineral-activated charcoal or hydrophobic resin) in adsorbing a given solute. Ex vivo studies were performed in order to evaluate the presence of cytokines (interleukin-1 beta and tumor necrosis factor-alpha), of cytokine (interleukin-1 beta and tumor necrosis factor-alpha)-inducing activities, and of the cytokine release in response to exogenous bacterial lipopolysaccharide by normal whole blood incubated with ultrafiltrate samples obtained at 15, 120, and 240 minutes after the start of treatment. The results of the present studies show the presence of immunomodulatory substances in the ultrafiltrate and the significant (P < 0.01) increase in the lipopolysaccharide-induced release of both interleukin-1 beta and tumor necrosis factor-alpha. The biological relevance of the ultrafiltrate and the possible relevance of the online, endogenous reinfusion are discussed.

Adsorption↗
PubMed2000

The effect of modified ultrafiltration on the amount of circulating endotoxins in children undergoing cardiopulmonary bypass.

OBJECTIVE: To determine whether the use of modified ultrafiltration during pediatric cardiopulmonary bypass (CPB) diminishes the load of circulating endotoxins. DESIGN: Single-arm prospective observational study. SETTING: A university hospital operating room and intensive care unit. PARTICIPANTS: Twenty children undergoing CPB for correction of various congenital heart diseases. INTERVENTIONS: The amount of endotoxins in plasma was measured during CPB and before and after modified ultrafiltration. The ultrafiltrate was assayed for the presence of endotoxins. Postoperatively, the children were followed with relevant infectious parameters and cultures. MEASUREMENTS AND MAIN RESULTS: The amount of endotoxins increased significantly during the CPB procedure (from a median of 1.3 ng [range, 0 to 13.7 ng] to 24.2 ng [range, 2.1 to 75.9 ng]). After termination of CPB, modified ultrafiltration was shown to lower the amount of circulating endotoxins in blood (from a median of 24.2 ng [range, 2.1 to 75.4 ng] to 9.0 [range, 0.1 to 40.6 ng]). The major bulk of this reduction in endotoxin load was retrieved in the ultrafiltrate (median of 11.9 ng [range, 0 to 12.1 ng]). CONCLUSION: This study strongly suggests that modified ultrafiltration decreases the amount of circulating endotoxins in children undergoing cardiac surgery.

Cardiopulmonary Bypass↗
PubMed2003

Peripherally inserted veno-venous ultrafiltration for rapid treatment of volume overloaded patients.

BACKGROUND: Veno-venous ultrafiltration may benefit patients with acute or chronic circulatory volume overload. Use of conventional systems, however, may be cumbersome, requiring physician placement of a double-lumen central venous catheter and use of a dedicated dialysis technician and apparatus. METHODS: A simplified peripheral ultrafiltration system including a miniaturized disposable circuit was evaluated in patients with volume-overload states. Separate intravenous catheters (16-18 G) for withdrawal and return of blood (blood flow <or= 40 mL/min, ultrafiltrate <or= 500 mL/h) were placed by nonphysician personnel in upper extremity veins. Twenty-five treatments of up to 8 hours were performed in 21 patients. RESULTS: The primary endpoint of greater than 1 L fluid removal in less than 8 hours was achieved in 23 of 25 treatments. On average, 2611 +/- 1002 mL (maximum 3,725 mL) of ultrafiltrate was removed per treatment (treatment period 6:43 +/- 1:47 hours:minutes). Patient weight decreased from 91.9 +/- 17.5 to 89.3 +/- 17.3 kg (P <.0001) after ultrafiltration. No major adverse events occurred. CONCLUSIONS: Rapid removal of extracellular and intravascular fluid volume excess can be safely achieved via peripherally inserted ultrafiltration without the need for central venous catheter placement.

Catheterization, Peripheral↗
PubMed1991

Measurement of phenytoin and carbamazepine in an ultrafiltrate of saliva.

We have introduced a method of collecting a prepurified sample of saliva in the mouth for the quantitative determination of phenytoin and carbamazepine. The patient places in the mouth an osmotic device that accumulates in greater than 8 min a volume of approximately 1.2 ml clear ultrafiltrate devoid of molecules greater than 12,000 daltons. The concentrations of phenytoin and carbamazepine in serum (total and free fractions), whole saliva, and the salivary ultrafiltrate from patients receiving anticonvulsant treatment were measured and correlated. The correlation coefficients r (p less than 0.001) for phenytoin were: total in serum and ultrafiltrate r = 0.92; free in serum and ultrafiltrate r = 0.93; whole saliva and ultrafiltrate r = 0.95. The correlation coefficients for carbamazepine were (in the same order) 0.90, 0.92, and 0.93. It is concluded that the use of an ultrafiltrate as a biological medium simplifies the diagnostic evaluation of free circulating phenytoin and carbamazepine concentrations for monitoring therapy.

Adolescent↗
PubMed2004

Recovery of bacteria by continuous renal replacement therapy in septic shock and by ultrafiltration from an in vitro model of bacteremia.

BACKGROUND: Severe sepsis is frequently associated with inflammation, multiple-organ dysfunction syndrome, and the accumulation of excess fluid that can be removed by continuous renal replacement therapy. Appropriate therapy for sepsis requires knowledge of the antibiotic susceptibility of the causative organism. However, bacterial isolation and identification are often unsuccessful. The objective of this study was to determine whether bacteria could be recovered from continuous renal replacement therapy ultrafiltrates of clinically septic patients who were either blood culture positive or repeatedly culture negative. DESIGN: Clinical study. SETTING: Adult medical intensive care unit. SUBJECTS: Six clinically septic, blood culture-positive or repeatedly culture-negative patients and four clinically nonseptic patients. INTERVENTIONS: We performed continuous renal replacement therapy on patients. In addition, we devised an in vitro system mimicking human bacteremia to determine whether bacteria traverse the hemofilter. In these experiments, a reservoir containing reconstituted blood was inoculated with Enterococcus faecalis and hemofiltered. The ultrafiltrates were centrifuged or secondarily filtered for bacterial recovery. MEASUREMENTS AND MAIN RESULTS: Bacterial pathogens were recovered in culture from ultrafiltrates of all the clinically septic patients. Ultrafiltrates of the nonseptic patients were sterile. E. faecalis, the bacterium inoculated into the reconstituted blood, was the only organism recovered from the in vitro-derived ultrafiltrates. CONCLUSIONS: Pathogenic bacteria were shown to traverse the hemofilter. Culture of ultrafiltrates of clinically septic, blood culture-negative patients may be useful in recovery of the etiological organism and confirmation of the clinical diagnosis and management of sepsis.

Adult↗
PubMed1998

Effect of on-line conductivity plasma ultrafiltrate kinetic modeling on cardiovascular stability of hemodialysis patients.

The aim of this multicenter, prospective, randomized cross-over study was to clarify whether on-line conductivity ultrafiltrate kinetic modeling (treatment B), as a substitute for sodium kinetic modeling, is capable of reducing intradialytic cardiovascular instability in comparison with standard treatment (treatment A), by reducing the sodium balance variability. Both treatments were performed by means of a modified hemodiafiltration technique. Treatment A was performed using fixed dialysate conductivity; treatment B made use of the dialysate conductivity derived from a conductivity kinetic model, in order to obtain an end-dialysis ultrafiltrate conductivity at each dialysis session that was equal to the mean value determined in the same patient during the four-week run-in period. Thus, during treatment B, the expected end-dialysis ultrafiltrate conductivity value of each patient should have been constant. The study was carried out according to a multicenter cross-over design of 16 weeks with two treatments (A or B), two sequences (1 = ABB and 2 = BAA), a run-in period of four weeks (period 1, treatment A), and three consecutive experimental periods of four weeks each. Analysis of variance for a cross-over design was used for the statistical analysis. Forty-nine hemodialysis patients prone to intradialytic hypotension (> 25% of sessions) were enrolled from 16 participating centers, and randomly assigned to either sequence 1 (26 patients) or sequence 2 (23 patients). Six patients dropped out and four were protocol violators, which left 39 patients selected for statistical analysis. There was no difference in the average dialysate conductivity, predialysis and end-dialysis plasma water ultrafiltrate conductivity or body weight between treatment A and treatment B. Thus, the observed mean sodium balance was not different and, as expected, only the intra-patient variability of end-dialysis ultrafiltrate conductivity (index of sodium balance variability) was reduced (21%). During treatment A, systolic blood pressure decreased by 23 mm Hg (95% confidence intervals 21 to 24 mm Hg) at the end of dialysis with respect to the pre-dialysis values. Treatment B reduced this intradialytic decrease (P = 0.001) with a maximum effect at the third hour of dialysis (4.4 mm Hg, 95% confidence intervals 1.9 to 6.9 mm Hg, 23% less than during treatment A, P 0.0005) without any period or carry-over effect (P = 0.53 and 0.08, respectively). There was no treatment effect on intradialytic diastolic blood pressure (P = 0.291). In conclusion, intradialytic cardiovascular stability was significantly improved by matching the interdialytic sodium load with intradialytic sodium removal using on-line conductivity ultrafiltrate kinetic modeling as an alternative to sodium kinetic modeling. Although highly significant, this effect was clinically not very large. By applying this conductivity kinetic model to patients with a more variable sodium intake from one session to another, a greater benefit can be expected.

Aged↗
PubMed1995

Systemic cardiovascular response in hemodialysis without and with ultrafiltration with membranes of high and low biocompatibility.

In order to test whether dialyzer membrane biocompatibility influences systemic cardiovascular function, we treated 8 hemodialysis patients (4 men and 4 women, aged 24-73 years) with a low-biocompatible (cuprophane) and a high-biocompatible (polyacrylonitrile) membrane in a randomized double-blind crossover protocol using bicarbonate hemodialysis without ultrafiltration for the first 60 min and with ultrafiltration for the remaining treatment time. Left ventricular function and systemic hemodynamics were assessed noninvasively at baseline and during treatment by Doppler echocardiography combined with external subclavian artery pulse trace calibrated with oscillometrically measured brachial artery blood pressures. There was no significant difference in the cardiovascular response to the 2 membranes, neither during isolated hemodialysis nor when ultrafiltration was added. Mean arterial pressure increased 10% (p < 0.001) during isolated hemodialysis and returned to baseline levels with ultrafiltration. The cardiac index decreased 22% (p < 0.001) during ultrafiltration, due to the greater decrease in left ventricular stroke index (30%, p < 0.001) than increase in heart rate (9%, p < 0.05). Total peripheral resistance increased 10% (p < 0.05) during isolated hemodialysis and a further 19% (p < 0.01) when ultrafiltration was added. Hence, profound cardiovascular alterations were observed during hemodialysis treatment; however, these changes were not related to the biocompatibility of the membranes.

Acrylic Resins↗
PubMed1998

Modified ultrafiltration in paediatric cardiopulmonary bypass.

Cardiopulmonary bypass (CPB), a nonphysiological procedure, is associated with haemodilution and the inflammatory response, causing the accumulation of body water and organ dysfunction. The purpose of this study was to evaluate the efficacy of modified ultrafiltration. Forty paediatric patients undergoing cardiac operations were randomized into a control group and a modified ultrafiltration group. Blood cells, protein and cytokine concentrations were recorded for 24 h postoperatively. As the fluid was removed at 50 ml/min, both blood cells and protein were concentrated by modified ultrafiltration (p < 0.001). The tumour necrosis factor (TNF)-alpha concentration was increased and interleukin-8 (IL-8) and endothelin (ET) concentrations were unaltered after ultrafiltration. After correction for albumin, TNF-alpha concentration changed little, and IL-8 and ET concentrations (36.75 +/- 12.35, 42.89 +/- 15.54) were decreased significantly (21.47 +/- 13.87, 26.06 +/- 12.54) after ultrafiltration. Modified ultrafiltration is an effective method for removing excess tissue fluid and concentrating blood after CPB. This technique can also filter out some cytokines.

Blood Cell Count↗