pcrrt congress london 2015 cvvhd is best! joseph a carcillo university of pittsburgh
TRANSCRIPT
PCRRT CongressLondon 2015
CVVHD is BestJoseph A Carcillo
University of Pittsburgh
Questions
bull Is there an optimal form of RRT in children independent of cause of AKI
bull Are there studies comparing outcome randomized by RRT modality in children
Dialysis (diffusive)
bull PD vs HD vs CVVHD vs CVVHDFndash Works with solute clearance across a
semi-permeable membranendash The greater the gradient the greater the
clearancendash The greater the solution exposure per
unit of time the greater the clearance
RRT for AKI Which Modality is Best
In-hospital mortality
Rabindranath et al Cochrane Database of Systematic Reviews (2007)
No Difference in Adult Survival
Dialysis - Diffusion
Ultrafiltration-Convection
Continuous Veno Venous HemofiltrationApplicable to following diseases
Fluid overload Congestive heart failure
Acute renal failure Crush syndrome
CVVH-Continuous Veno Venous Hemodialysis Applicable to following diseases
Acute renal failure Lactic acidosis
CVVHDF
ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
RRT for Pediatric AKI Which Modality is Best
40 49
81
0102030405060708090
100
Hemofiltration (N=106) Peritoneal Dialysis (N=59)
Hemodialysis (N=61)
Survival by Modality
Bunchman et al Pediatr Nephrol (2001) 161067ndash1071
Years of study 1992-1998N=226 Plt001 (HD vs other)
RRT modality (40 survival with HF vs 49 survival with PD vs 81 survival with HD Plt001 HD vs PD or HF)
P lt 001
Pediatric ARF Modality and Survival
S
urvi
val
Ped Neph 161067-1071 2001
Plt001
Plt001
(ns)
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Includes Flores Study
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
MortalityNo Difference
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Filter life Hemofiltration leads to a shorter filter life
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
2
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 1 The configuration of the Prisma continuous renal replacement therapy machine Different pumps control the rate of dialysate predilution and effluent The sampling port is used to obtain effluent for the clearance calculations described in this study
Copyright copy 2009 by the American Society for Artificial Internal Organs Published by Lippincott Williams amp Wilkins Inc
2
Middle-Molecule Clearance in CRRT In Vitro Convection Diffusion and Dialyzer AreaMesser Jennifer Mulcahy Brendan Fissell William
ASAIO Journal 55(3)224-226 MayJune 2009DOI 101097MAT0b013e318194b26c
Figure 1 Dialysate-side Ficoll clearance as a function of molecular weight Y-axis clearance in mlmin X-axis molecular weight Black lines 20 m2 dialyser Gray lines 04 m2 dialyser Solid lines continuous venovenous hemofiltration (CVVH) Dashed lines continuous venovenous hemodialysis (CVVHD)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
7
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD Pediatric Critical Care Medicine 5(3)269-274 May 2004 DOI 101097 01PCC00001235541255520
Figure 3 Urea clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run at 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) CVVHD had a superior clearance at all comparisons with a 15 greater clearance at 600 mLhr (p lt 001)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Questions
bull Is there an optimal form of RRT in children independent of cause of AKI
bull Are there studies comparing outcome randomized by RRT modality in children
Dialysis (diffusive)
bull PD vs HD vs CVVHD vs CVVHDFndash Works with solute clearance across a
semi-permeable membranendash The greater the gradient the greater the
clearancendash The greater the solution exposure per
unit of time the greater the clearance
RRT for AKI Which Modality is Best
In-hospital mortality
Rabindranath et al Cochrane Database of Systematic Reviews (2007)
No Difference in Adult Survival
Dialysis - Diffusion
Ultrafiltration-Convection
Continuous Veno Venous HemofiltrationApplicable to following diseases
Fluid overload Congestive heart failure
Acute renal failure Crush syndrome
CVVH-Continuous Veno Venous Hemodialysis Applicable to following diseases
Acute renal failure Lactic acidosis
CVVHDF
ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
RRT for Pediatric AKI Which Modality is Best
40 49
81
0102030405060708090
100
Hemofiltration (N=106) Peritoneal Dialysis (N=59)
Hemodialysis (N=61)
Survival by Modality
Bunchman et al Pediatr Nephrol (2001) 161067ndash1071
Years of study 1992-1998N=226 Plt001 (HD vs other)
RRT modality (40 survival with HF vs 49 survival with PD vs 81 survival with HD Plt001 HD vs PD or HF)
P lt 001
Pediatric ARF Modality and Survival
S
urvi
val
Ped Neph 161067-1071 2001
Plt001
Plt001
(ns)
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Includes Flores Study
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
MortalityNo Difference
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Filter life Hemofiltration leads to a shorter filter life
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
2
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 1 The configuration of the Prisma continuous renal replacement therapy machine Different pumps control the rate of dialysate predilution and effluent The sampling port is used to obtain effluent for the clearance calculations described in this study
Copyright copy 2009 by the American Society for Artificial Internal Organs Published by Lippincott Williams amp Wilkins Inc
2
Middle-Molecule Clearance in CRRT In Vitro Convection Diffusion and Dialyzer AreaMesser Jennifer Mulcahy Brendan Fissell William
ASAIO Journal 55(3)224-226 MayJune 2009DOI 101097MAT0b013e318194b26c
Figure 1 Dialysate-side Ficoll clearance as a function of molecular weight Y-axis clearance in mlmin X-axis molecular weight Black lines 20 m2 dialyser Gray lines 04 m2 dialyser Solid lines continuous venovenous hemofiltration (CVVH) Dashed lines continuous venovenous hemodialysis (CVVHD)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
7
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD Pediatric Critical Care Medicine 5(3)269-274 May 2004 DOI 101097 01PCC00001235541255520
Figure 3 Urea clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run at 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) CVVHD had a superior clearance at all comparisons with a 15 greater clearance at 600 mLhr (p lt 001)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Dialysis (diffusive)
bull PD vs HD vs CVVHD vs CVVHDFndash Works with solute clearance across a
semi-permeable membranendash The greater the gradient the greater the
clearancendash The greater the solution exposure per
unit of time the greater the clearance
RRT for AKI Which Modality is Best
In-hospital mortality
Rabindranath et al Cochrane Database of Systematic Reviews (2007)
No Difference in Adult Survival
Dialysis - Diffusion
Ultrafiltration-Convection
Continuous Veno Venous HemofiltrationApplicable to following diseases
Fluid overload Congestive heart failure
Acute renal failure Crush syndrome
CVVH-Continuous Veno Venous Hemodialysis Applicable to following diseases
Acute renal failure Lactic acidosis
CVVHDF
ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
RRT for Pediatric AKI Which Modality is Best
40 49
81
0102030405060708090
100
Hemofiltration (N=106) Peritoneal Dialysis (N=59)
Hemodialysis (N=61)
Survival by Modality
Bunchman et al Pediatr Nephrol (2001) 161067ndash1071
Years of study 1992-1998N=226 Plt001 (HD vs other)
RRT modality (40 survival with HF vs 49 survival with PD vs 81 survival with HD Plt001 HD vs PD or HF)
P lt 001
Pediatric ARF Modality and Survival
S
urvi
val
Ped Neph 161067-1071 2001
Plt001
Plt001
(ns)
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Includes Flores Study
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
MortalityNo Difference
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Filter life Hemofiltration leads to a shorter filter life
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
2
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 1 The configuration of the Prisma continuous renal replacement therapy machine Different pumps control the rate of dialysate predilution and effluent The sampling port is used to obtain effluent for the clearance calculations described in this study
Copyright copy 2009 by the American Society for Artificial Internal Organs Published by Lippincott Williams amp Wilkins Inc
2
Middle-Molecule Clearance in CRRT In Vitro Convection Diffusion and Dialyzer AreaMesser Jennifer Mulcahy Brendan Fissell William
ASAIO Journal 55(3)224-226 MayJune 2009DOI 101097MAT0b013e318194b26c
Figure 1 Dialysate-side Ficoll clearance as a function of molecular weight Y-axis clearance in mlmin X-axis molecular weight Black lines 20 m2 dialyser Gray lines 04 m2 dialyser Solid lines continuous venovenous hemofiltration (CVVH) Dashed lines continuous venovenous hemodialysis (CVVHD)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
7
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD Pediatric Critical Care Medicine 5(3)269-274 May 2004 DOI 101097 01PCC00001235541255520
Figure 3 Urea clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run at 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) CVVHD had a superior clearance at all comparisons with a 15 greater clearance at 600 mLhr (p lt 001)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
RRT for AKI Which Modality is Best
In-hospital mortality
Rabindranath et al Cochrane Database of Systematic Reviews (2007)
No Difference in Adult Survival
Dialysis - Diffusion
Ultrafiltration-Convection
Continuous Veno Venous HemofiltrationApplicable to following diseases
Fluid overload Congestive heart failure
Acute renal failure Crush syndrome
CVVH-Continuous Veno Venous Hemodialysis Applicable to following diseases
Acute renal failure Lactic acidosis
CVVHDF
ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
RRT for Pediatric AKI Which Modality is Best
40 49
81
0102030405060708090
100
Hemofiltration (N=106) Peritoneal Dialysis (N=59)
Hemodialysis (N=61)
Survival by Modality
Bunchman et al Pediatr Nephrol (2001) 161067ndash1071
Years of study 1992-1998N=226 Plt001 (HD vs other)
RRT modality (40 survival with HF vs 49 survival with PD vs 81 survival with HD Plt001 HD vs PD or HF)
P lt 001
Pediatric ARF Modality and Survival
S
urvi
val
Ped Neph 161067-1071 2001
Plt001
Plt001
(ns)
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Includes Flores Study
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
MortalityNo Difference
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Filter life Hemofiltration leads to a shorter filter life
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
2
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 1 The configuration of the Prisma continuous renal replacement therapy machine Different pumps control the rate of dialysate predilution and effluent The sampling port is used to obtain effluent for the clearance calculations described in this study
Copyright copy 2009 by the American Society for Artificial Internal Organs Published by Lippincott Williams amp Wilkins Inc
2
Middle-Molecule Clearance in CRRT In Vitro Convection Diffusion and Dialyzer AreaMesser Jennifer Mulcahy Brendan Fissell William
ASAIO Journal 55(3)224-226 MayJune 2009DOI 101097MAT0b013e318194b26c
Figure 1 Dialysate-side Ficoll clearance as a function of molecular weight Y-axis clearance in mlmin X-axis molecular weight Black lines 20 m2 dialyser Gray lines 04 m2 dialyser Solid lines continuous venovenous hemofiltration (CVVH) Dashed lines continuous venovenous hemodialysis (CVVHD)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
7
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD Pediatric Critical Care Medicine 5(3)269-274 May 2004 DOI 101097 01PCC00001235541255520
Figure 3 Urea clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run at 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) CVVHD had a superior clearance at all comparisons with a 15 greater clearance at 600 mLhr (p lt 001)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Dialysis - Diffusion
Ultrafiltration-Convection
Continuous Veno Venous HemofiltrationApplicable to following diseases
Fluid overload Congestive heart failure
Acute renal failure Crush syndrome
CVVH-Continuous Veno Venous Hemodialysis Applicable to following diseases
Acute renal failure Lactic acidosis
CVVHDF
ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
RRT for Pediatric AKI Which Modality is Best
40 49
81
0102030405060708090
100
Hemofiltration (N=106) Peritoneal Dialysis (N=59)
Hemodialysis (N=61)
Survival by Modality
Bunchman et al Pediatr Nephrol (2001) 161067ndash1071
Years of study 1992-1998N=226 Plt001 (HD vs other)
RRT modality (40 survival with HF vs 49 survival with PD vs 81 survival with HD Plt001 HD vs PD or HF)
P lt 001
Pediatric ARF Modality and Survival
S
urvi
val
Ped Neph 161067-1071 2001
Plt001
Plt001
(ns)
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Includes Flores Study
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
MortalityNo Difference
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Filter life Hemofiltration leads to a shorter filter life
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
2
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 1 The configuration of the Prisma continuous renal replacement therapy machine Different pumps control the rate of dialysate predilution and effluent The sampling port is used to obtain effluent for the clearance calculations described in this study
Copyright copy 2009 by the American Society for Artificial Internal Organs Published by Lippincott Williams amp Wilkins Inc
2
Middle-Molecule Clearance in CRRT In Vitro Convection Diffusion and Dialyzer AreaMesser Jennifer Mulcahy Brendan Fissell William
ASAIO Journal 55(3)224-226 MayJune 2009DOI 101097MAT0b013e318194b26c
Figure 1 Dialysate-side Ficoll clearance as a function of molecular weight Y-axis clearance in mlmin X-axis molecular weight Black lines 20 m2 dialyser Gray lines 04 m2 dialyser Solid lines continuous venovenous hemofiltration (CVVH) Dashed lines continuous venovenous hemodialysis (CVVHD)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
7
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD Pediatric Critical Care Medicine 5(3)269-274 May 2004 DOI 101097 01PCC00001235541255520
Figure 3 Urea clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run at 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) CVVHD had a superior clearance at all comparisons with a 15 greater clearance at 600 mLhr (p lt 001)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Ultrafiltration-Convection
Continuous Veno Venous HemofiltrationApplicable to following diseases
Fluid overload Congestive heart failure
Acute renal failure Crush syndrome
CVVH-Continuous Veno Venous Hemodialysis Applicable to following diseases
Acute renal failure Lactic acidosis
CVVHDF
ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
RRT for Pediatric AKI Which Modality is Best
40 49
81
0102030405060708090
100
Hemofiltration (N=106) Peritoneal Dialysis (N=59)
Hemodialysis (N=61)
Survival by Modality
Bunchman et al Pediatr Nephrol (2001) 161067ndash1071
Years of study 1992-1998N=226 Plt001 (HD vs other)
RRT modality (40 survival with HF vs 49 survival with PD vs 81 survival with HD Plt001 HD vs PD or HF)
P lt 001
Pediatric ARF Modality and Survival
S
urvi
val
Ped Neph 161067-1071 2001
Plt001
Plt001
(ns)
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Includes Flores Study
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
MortalityNo Difference
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Filter life Hemofiltration leads to a shorter filter life
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
2
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 1 The configuration of the Prisma continuous renal replacement therapy machine Different pumps control the rate of dialysate predilution and effluent The sampling port is used to obtain effluent for the clearance calculations described in this study
Copyright copy 2009 by the American Society for Artificial Internal Organs Published by Lippincott Williams amp Wilkins Inc
2
Middle-Molecule Clearance in CRRT In Vitro Convection Diffusion and Dialyzer AreaMesser Jennifer Mulcahy Brendan Fissell William
ASAIO Journal 55(3)224-226 MayJune 2009DOI 101097MAT0b013e318194b26c
Figure 1 Dialysate-side Ficoll clearance as a function of molecular weight Y-axis clearance in mlmin X-axis molecular weight Black lines 20 m2 dialyser Gray lines 04 m2 dialyser Solid lines continuous venovenous hemofiltration (CVVH) Dashed lines continuous venovenous hemodialysis (CVVHD)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
7
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD Pediatric Critical Care Medicine 5(3)269-274 May 2004 DOI 101097 01PCC00001235541255520
Figure 3 Urea clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run at 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) CVVHD had a superior clearance at all comparisons with a 15 greater clearance at 600 mLhr (p lt 001)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Continuous Veno Venous HemofiltrationApplicable to following diseases
Fluid overload Congestive heart failure
Acute renal failure Crush syndrome
CVVH-Continuous Veno Venous Hemodialysis Applicable to following diseases
Acute renal failure Lactic acidosis
CVVHDF
ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
RRT for Pediatric AKI Which Modality is Best
40 49
81
0102030405060708090
100
Hemofiltration (N=106) Peritoneal Dialysis (N=59)
Hemodialysis (N=61)
Survival by Modality
Bunchman et al Pediatr Nephrol (2001) 161067ndash1071
Years of study 1992-1998N=226 Plt001 (HD vs other)
RRT modality (40 survival with HF vs 49 survival with PD vs 81 survival with HD Plt001 HD vs PD or HF)
P lt 001
Pediatric ARF Modality and Survival
S
urvi
val
Ped Neph 161067-1071 2001
Plt001
Plt001
(ns)
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Includes Flores Study
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
MortalityNo Difference
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Filter life Hemofiltration leads to a shorter filter life
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
2
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 1 The configuration of the Prisma continuous renal replacement therapy machine Different pumps control the rate of dialysate predilution and effluent The sampling port is used to obtain effluent for the clearance calculations described in this study
Copyright copy 2009 by the American Society for Artificial Internal Organs Published by Lippincott Williams amp Wilkins Inc
2
Middle-Molecule Clearance in CRRT In Vitro Convection Diffusion and Dialyzer AreaMesser Jennifer Mulcahy Brendan Fissell William
ASAIO Journal 55(3)224-226 MayJune 2009DOI 101097MAT0b013e318194b26c
Figure 1 Dialysate-side Ficoll clearance as a function of molecular weight Y-axis clearance in mlmin X-axis molecular weight Black lines 20 m2 dialyser Gray lines 04 m2 dialyser Solid lines continuous venovenous hemofiltration (CVVH) Dashed lines continuous venovenous hemodialysis (CVVHD)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
7
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD Pediatric Critical Care Medicine 5(3)269-274 May 2004 DOI 101097 01PCC00001235541255520
Figure 3 Urea clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run at 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) CVVHD had a superior clearance at all comparisons with a 15 greater clearance at 600 mLhr (p lt 001)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
CVVH-Continuous Veno Venous Hemodialysis Applicable to following diseases
Acute renal failure Lactic acidosis
CVVHDF
ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
RRT for Pediatric AKI Which Modality is Best
40 49
81
0102030405060708090
100
Hemofiltration (N=106) Peritoneal Dialysis (N=59)
Hemodialysis (N=61)
Survival by Modality
Bunchman et al Pediatr Nephrol (2001) 161067ndash1071
Years of study 1992-1998N=226 Plt001 (HD vs other)
RRT modality (40 survival with HF vs 49 survival with PD vs 81 survival with HD Plt001 HD vs PD or HF)
P lt 001
Pediatric ARF Modality and Survival
S
urvi
val
Ped Neph 161067-1071 2001
Plt001
Plt001
(ns)
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Includes Flores Study
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
MortalityNo Difference
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Filter life Hemofiltration leads to a shorter filter life
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
2
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 1 The configuration of the Prisma continuous renal replacement therapy machine Different pumps control the rate of dialysate predilution and effluent The sampling port is used to obtain effluent for the clearance calculations described in this study
Copyright copy 2009 by the American Society for Artificial Internal Organs Published by Lippincott Williams amp Wilkins Inc
2
Middle-Molecule Clearance in CRRT In Vitro Convection Diffusion and Dialyzer AreaMesser Jennifer Mulcahy Brendan Fissell William
ASAIO Journal 55(3)224-226 MayJune 2009DOI 101097MAT0b013e318194b26c
Figure 1 Dialysate-side Ficoll clearance as a function of molecular weight Y-axis clearance in mlmin X-axis molecular weight Black lines 20 m2 dialyser Gray lines 04 m2 dialyser Solid lines continuous venovenous hemofiltration (CVVH) Dashed lines continuous venovenous hemodialysis (CVVHD)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
7
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD Pediatric Critical Care Medicine 5(3)269-274 May 2004 DOI 101097 01PCC00001235541255520
Figure 3 Urea clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run at 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) CVVHD had a superior clearance at all comparisons with a 15 greater clearance at 600 mLhr (p lt 001)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
CVVHDF
ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
RRT for Pediatric AKI Which Modality is Best
40 49
81
0102030405060708090
100
Hemofiltration (N=106) Peritoneal Dialysis (N=59)
Hemodialysis (N=61)
Survival by Modality
Bunchman et al Pediatr Nephrol (2001) 161067ndash1071
Years of study 1992-1998N=226 Plt001 (HD vs other)
RRT modality (40 survival with HF vs 49 survival with PD vs 81 survival with HD Plt001 HD vs PD or HF)
P lt 001
Pediatric ARF Modality and Survival
S
urvi
val
Ped Neph 161067-1071 2001
Plt001
Plt001
(ns)
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Includes Flores Study
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
MortalityNo Difference
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Filter life Hemofiltration leads to a shorter filter life
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
2
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 1 The configuration of the Prisma continuous renal replacement therapy machine Different pumps control the rate of dialysate predilution and effluent The sampling port is used to obtain effluent for the clearance calculations described in this study
Copyright copy 2009 by the American Society for Artificial Internal Organs Published by Lippincott Williams amp Wilkins Inc
2
Middle-Molecule Clearance in CRRT In Vitro Convection Diffusion and Dialyzer AreaMesser Jennifer Mulcahy Brendan Fissell William
ASAIO Journal 55(3)224-226 MayJune 2009DOI 101097MAT0b013e318194b26c
Figure 1 Dialysate-side Ficoll clearance as a function of molecular weight Y-axis clearance in mlmin X-axis molecular weight Black lines 20 m2 dialyser Gray lines 04 m2 dialyser Solid lines continuous venovenous hemofiltration (CVVH) Dashed lines continuous venovenous hemodialysis (CVVHD)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
7
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD Pediatric Critical Care Medicine 5(3)269-274 May 2004 DOI 101097 01PCC00001235541255520
Figure 3 Urea clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run at 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) CVVHD had a superior clearance at all comparisons with a 15 greater clearance at 600 mLhr (p lt 001)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
RRT for Pediatric AKI Which Modality is Best
40 49
81
0102030405060708090
100
Hemofiltration (N=106) Peritoneal Dialysis (N=59)
Hemodialysis (N=61)
Survival by Modality
Bunchman et al Pediatr Nephrol (2001) 161067ndash1071
Years of study 1992-1998N=226 Plt001 (HD vs other)
RRT modality (40 survival with HF vs 49 survival with PD vs 81 survival with HD Plt001 HD vs PD or HF)
P lt 001
Pediatric ARF Modality and Survival
S
urvi
val
Ped Neph 161067-1071 2001
Plt001
Plt001
(ns)
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Includes Flores Study
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
MortalityNo Difference
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Filter life Hemofiltration leads to a shorter filter life
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
2
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 1 The configuration of the Prisma continuous renal replacement therapy machine Different pumps control the rate of dialysate predilution and effluent The sampling port is used to obtain effluent for the clearance calculations described in this study
Copyright copy 2009 by the American Society for Artificial Internal Organs Published by Lippincott Williams amp Wilkins Inc
2
Middle-Molecule Clearance in CRRT In Vitro Convection Diffusion and Dialyzer AreaMesser Jennifer Mulcahy Brendan Fissell William
ASAIO Journal 55(3)224-226 MayJune 2009DOI 101097MAT0b013e318194b26c
Figure 1 Dialysate-side Ficoll clearance as a function of molecular weight Y-axis clearance in mlmin X-axis molecular weight Black lines 20 m2 dialyser Gray lines 04 m2 dialyser Solid lines continuous venovenous hemofiltration (CVVH) Dashed lines continuous venovenous hemodialysis (CVVHD)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
7
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD Pediatric Critical Care Medicine 5(3)269-274 May 2004 DOI 101097 01PCC00001235541255520
Figure 3 Urea clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run at 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) CVVHD had a superior clearance at all comparisons with a 15 greater clearance at 600 mLhr (p lt 001)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
RRT for Pediatric AKI Which Modality is Best
40 49
81
0102030405060708090
100
Hemofiltration (N=106) Peritoneal Dialysis (N=59)
Hemodialysis (N=61)
Survival by Modality
Bunchman et al Pediatr Nephrol (2001) 161067ndash1071
Years of study 1992-1998N=226 Plt001 (HD vs other)
RRT modality (40 survival with HF vs 49 survival with PD vs 81 survival with HD Plt001 HD vs PD or HF)
P lt 001
Pediatric ARF Modality and Survival
S
urvi
val
Ped Neph 161067-1071 2001
Plt001
Plt001
(ns)
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Includes Flores Study
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
MortalityNo Difference
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Filter life Hemofiltration leads to a shorter filter life
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
2
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 1 The configuration of the Prisma continuous renal replacement therapy machine Different pumps control the rate of dialysate predilution and effluent The sampling port is used to obtain effluent for the clearance calculations described in this study
Copyright copy 2009 by the American Society for Artificial Internal Organs Published by Lippincott Williams amp Wilkins Inc
2
Middle-Molecule Clearance in CRRT In Vitro Convection Diffusion and Dialyzer AreaMesser Jennifer Mulcahy Brendan Fissell William
ASAIO Journal 55(3)224-226 MayJune 2009DOI 101097MAT0b013e318194b26c
Figure 1 Dialysate-side Ficoll clearance as a function of molecular weight Y-axis clearance in mlmin X-axis molecular weight Black lines 20 m2 dialyser Gray lines 04 m2 dialyser Solid lines continuous venovenous hemofiltration (CVVH) Dashed lines continuous venovenous hemodialysis (CVVHD)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
7
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD Pediatric Critical Care Medicine 5(3)269-274 May 2004 DOI 101097 01PCC00001235541255520
Figure 3 Urea clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run at 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) CVVHD had a superior clearance at all comparisons with a 15 greater clearance at 600 mLhr (p lt 001)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Pediatric ARF Modality and Survival
S
urvi
val
Ped Neph 161067-1071 2001
Plt001
Plt001
(ns)
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Includes Flores Study
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
MortalityNo Difference
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Filter life Hemofiltration leads to a shorter filter life
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
2
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 1 The configuration of the Prisma continuous renal replacement therapy machine Different pumps control the rate of dialysate predilution and effluent The sampling port is used to obtain effluent for the clearance calculations described in this study
Copyright copy 2009 by the American Society for Artificial Internal Organs Published by Lippincott Williams amp Wilkins Inc
2
Middle-Molecule Clearance in CRRT In Vitro Convection Diffusion and Dialyzer AreaMesser Jennifer Mulcahy Brendan Fissell William
ASAIO Journal 55(3)224-226 MayJune 2009DOI 101097MAT0b013e318194b26c
Figure 1 Dialysate-side Ficoll clearance as a function of molecular weight Y-axis clearance in mlmin X-axis molecular weight Black lines 20 m2 dialyser Gray lines 04 m2 dialyser Solid lines continuous venovenous hemofiltration (CVVH) Dashed lines continuous venovenous hemodialysis (CVVHD)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
7
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD Pediatric Critical Care Medicine 5(3)269-274 May 2004 DOI 101097 01PCC00001235541255520
Figure 3 Urea clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run at 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) CVVHD had a superior clearance at all comparisons with a 15 greater clearance at 600 mLhr (p lt 001)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Includes Flores Study
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
MortalityNo Difference
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Filter life Hemofiltration leads to a shorter filter life
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
2
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 1 The configuration of the Prisma continuous renal replacement therapy machine Different pumps control the rate of dialysate predilution and effluent The sampling port is used to obtain effluent for the clearance calculations described in this study
Copyright copy 2009 by the American Society for Artificial Internal Organs Published by Lippincott Williams amp Wilkins Inc
2
Middle-Molecule Clearance in CRRT In Vitro Convection Diffusion and Dialyzer AreaMesser Jennifer Mulcahy Brendan Fissell William
ASAIO Journal 55(3)224-226 MayJune 2009DOI 101097MAT0b013e318194b26c
Figure 1 Dialysate-side Ficoll clearance as a function of molecular weight Y-axis clearance in mlmin X-axis molecular weight Black lines 20 m2 dialyser Gray lines 04 m2 dialyser Solid lines continuous venovenous hemofiltration (CVVH) Dashed lines continuous venovenous hemodialysis (CVVHD)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
7
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD Pediatric Critical Care Medicine 5(3)269-274 May 2004 DOI 101097 01PCC00001235541255520
Figure 3 Urea clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run at 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) CVVHD had a superior clearance at all comparisons with a 15 greater clearance at 600 mLhr (p lt 001)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
MortalityNo Difference
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Filter life Hemofiltration leads to a shorter filter life
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
2
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 1 The configuration of the Prisma continuous renal replacement therapy machine Different pumps control the rate of dialysate predilution and effluent The sampling port is used to obtain effluent for the clearance calculations described in this study
Copyright copy 2009 by the American Society for Artificial Internal Organs Published by Lippincott Williams amp Wilkins Inc
2
Middle-Molecule Clearance in CRRT In Vitro Convection Diffusion and Dialyzer AreaMesser Jennifer Mulcahy Brendan Fissell William
ASAIO Journal 55(3)224-226 MayJune 2009DOI 101097MAT0b013e318194b26c
Figure 1 Dialysate-side Ficoll clearance as a function of molecular weight Y-axis clearance in mlmin X-axis molecular weight Black lines 20 m2 dialyser Gray lines 04 m2 dialyser Solid lines continuous venovenous hemofiltration (CVVH) Dashed lines continuous venovenous hemodialysis (CVVHD)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
7
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD Pediatric Critical Care Medicine 5(3)269-274 May 2004 DOI 101097 01PCC00001235541255520
Figure 3 Urea clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run at 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) CVVHD had a superior clearance at all comparisons with a 15 greater clearance at 600 mLhr (p lt 001)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Friedrich JO Wald R Bagshaw SM Burns KE Adhikari NK Crit Care lsquoContinuousrsquo Hemofiltration compared to hemodialysis for acute kidney injury systematic review and meta-analysis Crit Care 2012 Aug 616(4)R146 doi 101186cc11458
Filter life Hemofiltration leads to a shorter filter life
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
2
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 1 The configuration of the Prisma continuous renal replacement therapy machine Different pumps control the rate of dialysate predilution and effluent The sampling port is used to obtain effluent for the clearance calculations described in this study
Copyright copy 2009 by the American Society for Artificial Internal Organs Published by Lippincott Williams amp Wilkins Inc
2
Middle-Molecule Clearance in CRRT In Vitro Convection Diffusion and Dialyzer AreaMesser Jennifer Mulcahy Brendan Fissell William
ASAIO Journal 55(3)224-226 MayJune 2009DOI 101097MAT0b013e318194b26c
Figure 1 Dialysate-side Ficoll clearance as a function of molecular weight Y-axis clearance in mlmin X-axis molecular weight Black lines 20 m2 dialyser Gray lines 04 m2 dialyser Solid lines continuous venovenous hemofiltration (CVVH) Dashed lines continuous venovenous hemodialysis (CVVHD)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
7
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD Pediatric Critical Care Medicine 5(3)269-274 May 2004 DOI 101097 01PCC00001235541255520
Figure 3 Urea clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run at 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) CVVHD had a superior clearance at all comparisons with a 15 greater clearance at 600 mLhr (p lt 001)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
2
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 1 The configuration of the Prisma continuous renal replacement therapy machine Different pumps control the rate of dialysate predilution and effluent The sampling port is used to obtain effluent for the clearance calculations described in this study
Copyright copy 2009 by the American Society for Artificial Internal Organs Published by Lippincott Williams amp Wilkins Inc
2
Middle-Molecule Clearance in CRRT In Vitro Convection Diffusion and Dialyzer AreaMesser Jennifer Mulcahy Brendan Fissell William
ASAIO Journal 55(3)224-226 MayJune 2009DOI 101097MAT0b013e318194b26c
Figure 1 Dialysate-side Ficoll clearance as a function of molecular weight Y-axis clearance in mlmin X-axis molecular weight Black lines 20 m2 dialyser Gray lines 04 m2 dialyser Solid lines continuous venovenous hemofiltration (CVVH) Dashed lines continuous venovenous hemodialysis (CVVHD)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
7
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD Pediatric Critical Care Medicine 5(3)269-274 May 2004 DOI 101097 01PCC00001235541255520
Figure 3 Urea clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run at 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) CVVHD had a superior clearance at all comparisons with a 15 greater clearance at 600 mLhr (p lt 001)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Copyright copy 2009 by the American Society for Artificial Internal Organs Published by Lippincott Williams amp Wilkins Inc
2
Middle-Molecule Clearance in CRRT In Vitro Convection Diffusion and Dialyzer AreaMesser Jennifer Mulcahy Brendan Fissell William
ASAIO Journal 55(3)224-226 MayJune 2009DOI 101097MAT0b013e318194b26c
Figure 1 Dialysate-side Ficoll clearance as a function of molecular weight Y-axis clearance in mlmin X-axis molecular weight Black lines 20 m2 dialyser Gray lines 04 m2 dialyser Solid lines continuous venovenous hemofiltration (CVVH) Dashed lines continuous venovenous hemodialysis (CVVHD)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
7
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD Pediatric Critical Care Medicine 5(3)269-274 May 2004 DOI 101097 01PCC00001235541255520
Figure 3 Urea clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run at 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) CVVHD had a superior clearance at all comparisons with a 15 greater clearance at 600 mLhr (p lt 001)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
7
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD Pediatric Critical Care Medicine 5(3)269-274 May 2004 DOI 101097 01PCC00001235541255520
Figure 3 Urea clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run at 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) CVVHD had a superior clearance at all comparisons with a 15 greater clearance at 600 mLhr (p lt 001)
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
copy2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Published by Lippincott Williams amp Wilkins Inc
8
Comparison of solute clearance in three modes of continuous renal replacement therapyParakininkas Daiva Greenbaum Larry MD PhD
Pediatric Critical Care Medicine 5(3)269-274 May 2004DOI 10109701PCC00001235541255520
Figure 4 Creatinine clearance data for predilution continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD) over changing rates of either replacement fluid or dialysis fluid Blood flow was kept at 60 mLmin while predilution or dialysate was run 600 mLhr (167 of blood flow rate) 1200 mLhr (33 of blood flow rate) or 1800 mLhr (50 of blood flow rate) The clearance of CVVHD was 15 higher at both 1200 mLhr and 1800 mLhr (p lt 05) The 10 difference at 600 mLhr was not statistically significant
Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
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Variable1
Univariate Odds Ratio (95 confidence interval)
Multivariate Odds Ratio (95 confidence interval)
Percentage of fluid overload
102 (101-103)a 103 (101-105)a
Oncologic diagnosis 161 (094-276)b 316 (164-607)c
Diagnosis of MODS 554 (269-1141)d 466 (204-1065)d
Convective CRRT modality
048 (030-077)a 080 (041-155)
PRISM II score at PICU admission
104 (101-106)a 102 (099-105)
Inotrope no 150 (122-185)d 126 (099-160)b
Fluid overload times convective CRRT modality
NA 098 (095-099)a
Sutherland SM Zappitelli M Alexander SR Chua AN Brophy PD Bunchman TE Hackbarth R Somers MJ Baum M Symons JM Flores FX Benfield M Askenazi D Chand D Fortenberry JD Mahan JD McBryde K Blowey D Goldstein SL Fluid overload and mortality in children receiving continuous renal replacement therapy the prospective pediatric continuous renal replacement therapy registryAm J Kidney Dis 2010 Feb55(2)316-25 doi 101053jajkd200910048 Epub 2009 Dec 30
Includes CVVH + CVVHDF
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
The nomenclature is fraught with confusionBecause even during intermittent hemodialysis hemofiltration is performed for fluid removalLeading us to the straw manhellip
Since almost all PICU patients are fluid overloadedor at the least require fluid to be removed becauseso much intravenous fluid is being givenhellipOf course All patients on CRRT need to have CONVECTIVE therapy for fluid removal
The question is whether one should also perform Hemodialysis in what I consider CVVHDF We do this Because HD gives maximum clearance with maximumfilter life whereas HF gives needed fluid removal
My question for Tim is lsquoIn your present study do you continue hemofiltration for fluid removal when youcrossover to the hemodialysis armrsquo
Then of course convection is King But dialysis is his Queen or as in the case of the UK convection is Queen and dialysis is her husband
- Questions
- Dialysis (diffusive)
- RRT for AKI Which Modality is Best
- Dialysis - Diffusion
- Ultrafiltration-Convection
- Continuous Veno Venous Hemofiltration
- CVVH-Continuous Veno Venous Hemodialysis
- CVVHDF
- ECMO can be used as a stable base filtration therapies in the very small or in the hemodynamically unstable patient
- RRT for Pediatric AKI Which Modality is Best
- Pediatric ARF Modality and Survival
- PowerPoint Presentation
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-