USE OF PERITONEAL-DIALYSIS, CONTINUOUS ARTERIOVENOUS HEMOFILTRATION, AND CONTINUOUS ARTERIOVENOUS HEMODIAFILTRATION FOR REMOVAL OF AMMONIUM-CHLORIDE AND GLUTAMINE IN RABBITS

Objective: We compared the ability of peritoneal dialysis, hemofiltrat ion, and continuous hemodiafiltration to remove infused ammonium chlor ide. Study design: Anesthetized adult rabbits received an intravenous infusion of ammonium chloride, Two methods of removal of ammonium chlo ride were performed in each animal and compared. In group 1 (n = 6), p eritoneal dialysis (dialysate = 75 ml . kg(-1)) and continuous arterio venous hemofiltration (CAVH) with a polysulfone 800 cm(2) hemofilter ( Minifilter Plus; Amicon Division, W. R. Grace and Co., Danvers, Mass.) were simultaneously performed for 40 minutes. In group 2 (n = 6), per itoneal dialysis and continuous arteriovenous hemodiafiltration (CAVHD ) (dialysate flow = 1000 ml . hr(-1)) were simultaneous performed for 40 minutes. In group 3 (n = 6), CAVH and CAVHD were performed successi vely in random order for 30 minutes each. Results: Animals had high an d stable ammonium chloride and glutamine plasma levels during the expe rimental procedure. No significant difference in ammonium chloride cle arance was observed between PD and CAVH (group 1), In comparison with PD or CAVH, CAVHD resulted in significantly higher clearances of ammon ium chloride (40% +/- 10% vs 96% +/- 34%, respectively) and of glutami ne (195% +/- 17% vs 77% +/- 25%, respectively). Conclusion: The overal l results indicate that CAVHD should be considered for hyperammonemia when peritoneal dialysis is indicated but unfeasible or inefficient.