CRRT Terminology

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  • This method is used very rarely. The interest is only to remove an excess of fluid and salt in the extracellular sector like in chronic congestive hart failure patients (Dr Paganini, Cleveland Clinic, USA / Dr Canaud, Montpellier, France). Note that the TMP reached in this method does not exceed 30 mmHg (over 50 mmHg in CAVH and CVVH).
  • This method is used very rarely. The interest is only to remove an excess of fluid and salt in the extracellular sector like in chronic congestive hart failure patients (Dr Paganini, Cleveland Clinic, USA / Dr Canaud, Montpellier, France). Note that the TMP reached in this method does not exceed 30 mmHg (over 50 mmHg in CAVH and CVVH).
  • This method is used very rarely. The interest is only to remove an excess of fluid and salt in the extracellular sector like in chronic congestive hart failure patients (Dr Paganini, Cleveland Clinic, USA / Dr Canaud, Montpellier, France). Note that the TMP reached in this method does not exceed 30 mmHg (over 50 mmHg in CAVH and CVVH).
  • This method is used very rarely. The interest is only to remove an excess of fluid and salt in the extracellular sector like in chronic congestive hart failure patients (Dr Paganini, Cleveland Clinic, USA / Dr Canaud, Montpellier, France). Note that the TMP reached in this method does not exceed 30 mmHg (over 50 mmHg in CAVH and CVVH).
  • This method is used very rarely. The interest is only to remove an excess of fluid and salt in the extracellular sector like in chronic congestive hart failure patients (Dr Paganini, Cleveland Clinic, USA / Dr Canaud, Montpellier, France). Note that the TMP reached in this method does not exceed 30 mmHg (over 50 mmHg in CAVH and CVVH).
  • This method is used very rarely. The interest is only to remove an excess of fluid and salt in the extracellular sector like in chronic congestive hart failure patients (Dr Paganini, Cleveland Clinic, USA / Dr Canaud, Montpellier, France). Note that the TMP reached in this method does not exceed 30 mmHg (over 50 mmHg in CAVH and CVVH).
  • CRRT Terminology

    1. 1. CRRT TERMINOLOGY Stefano Picca, MD D ept. of Nephrology and Urology, Dialysis Unit “ Bambino Gesù” Pediatric Research Hospital ROMA, Italy 6th International Conference on Pediatric C ontinuous Renal Replacement Therapy Rome,Italy. 2010, April 8-10
    2. 2. <ul><li>… everchanging array of names and abbreviations… </li></ul><ul><li>… lack of standardization… creates unnecessary confusion…prevents accurate comparisons and multicenter research, and is scientifically undesirable… </li></ul>Bellomo, Ronco, Mehta, AJKD,1996 CRRT modalities…
    3. 3. Gibney N, Kimmel PL, Lazarus M, 2000
    4. 4. CRRT NOMENCLATURE PHYSICAL PRINCIPLE TREATMENT DURATION CONVECTION (ultrafiltration) DIFFUSION (dialysis) CONVECTION + DIFFUSION A B P A B from Ricci et al, 2009
    5. 5. <ul><li>SCUF </li></ul><ul><li>S low C ontinuous U ltra F iltration </li></ul><ul><li>V enovenous Circuit </li></ul><ul><li>Slow ultrafiltration </li></ul><ul><li>No substitution fluid </li></ul>DEFINITIONS (1) Filtrate collecting device
    6. 6. <ul><li>CVVH (postdilution) </li></ul><ul><li>C ontinuous </li></ul><ul><li>V eno V enous </li></ul><ul><li>H emofiltration </li></ul><ul><li>V enovenous Circuit </li></ul><ul><li>High ultrafiltration </li></ul><ul><li>Substitution fluid </li></ul>DEFINITIONS (2) Filtrate collecting device Replace-ment fluid
    7. 7. <ul><li>CVVH (predilution) </li></ul><ul><li>C ontinuous </li></ul><ul><li>V eno V enous </li></ul><ul><li>H emofiltration </li></ul><ul><li>V enovenous Circuit </li></ul><ul><li>High ultrafiltration </li></ul><ul><li>Substitution fluid </li></ul>DEFINITIONS (3) Filtrate Replace-ment fluid Replace-ment fluid
    8. 8. <ul><li>CVVHD </li></ul><ul><li>C ontinuous </li></ul><ul><li>V eno V enous </li></ul><ul><li>H emo D ialysis </li></ul><ul><li>V enovenous Circuit </li></ul><ul><li>Dialysate (diffusion) </li></ul><ul><li>Low ultrafiltration (convection) , usually BW loss </li></ul><ul><li>No substitution fluid </li></ul>DEFINITIONS (4) Filtrate- Diaysate Dialysate
    9. 9. <ul><li>CVVHDF </li></ul><ul><li>C ontinuous </li></ul><ul><li>V eno V enous </li></ul><ul><li>H emo D ia F iltration </li></ul><ul><li>V enovenous Circuit </li></ul><ul><li>Dialysate (diffusion) </li></ul><ul><li>High ultrafiltration (convection) </li></ul><ul><li>Substitution fluid </li></ul>DEFINITIONS (5) Replace-ment fluid Filtrate- Diaysate Dialysate
    10. 10. DEFINITIONS: flows in children (6) Replace-ment fluid Filtrate- Diaysate Dialysate Qb: blood flow (from 10 ml/kg/min in infants to 150-200 ml/min in adolescents) Qd: dialysate flow (from 200 to 5000 ml/h) Quf: ultrafiltration rate (2000 ml/1.73 m 2 /h or?)
    11. 11. MISCELLANEOUS TECHNIQUES: HYBRID ( 1 ) <ul><li>Sustained Low Efficiency Dialysis (SLED) </li></ul><ul><li>Sustained Low Efficiency Daily Dialysis (SLEDD) </li></ul><ul><li>Prolonged Intermittent Daily RRT (PDIRRT) </li></ul><ul><li>Extended Dialysis (ED) </li></ul><ul><li>Extended Daily Dialysis (EDD) </li></ul><ul><li>Extended Daily Dialysis with filtration (EDDf) </li></ul><ul><li>In adults : </li></ul><ul><li>Reduced blood flow (100-200 ml / min) </li></ul><ul><li>Reduced dialysate flow (100-200 ml / min) </li></ul><ul><li>10-12 hours a day </li></ul>
    12. 12. MISCELLANEOUS TECHNIQUES: HYBRID (2) from Baldwin, 2009
    13. 13. Adapted from Ronco, 2006 MISCELLANEOUS TECHNIQUES (3) <ul><li>high-volume hemofiltration: </li></ul><ul><li>In adults, claimed to be more efficient in: </li></ul><ul><li>mediators removal </li></ul><ul><li>hemodynamics </li></ul><ul><li>improvement of immune </li></ul><ul><li>dysfunction </li></ul>
    14. 14. “ MAXIMAL”(?) EFFICIENCY IN CVVH ADULT-CHILD-NEONATE BW (kg) TBW (l) Qb (ml/min) UF/h (=K urea) (l/h) K urea per liter of TBW (l/h) NEONATE 3 2.4 30 0.25 0.10 CHILD 25 15 80 1.2 0.08 ADULT 70 42 150 2.5 0.05
    15. 15. <ul><li>PUBMED, March 2010: </li></ul><ul><li>CVVHD-hemodiafiltration: 58 post-2000 papers </li></ul><ul><li>40/58 use the acronym CVVHD incorrectly </li></ul><ul><li>15/40 incorrect definition in nephrology journals </li></ul><ul><li>15/40 incorrect definition in IC journals </li></ul>
    16. 16. Word: a speech sound or series of speech sounds that symbolizes and communicates a meaning usually without being divisible into smaller units capable of independent use. Merrian-Webster on line, 2010 (www.merriam-webster.com) CVVHD CHP CPFA CAVHDF HVHF CVVHDF CAVH CRRT PE SLEDD CVVHD CVVH CAVHD CVVHDF SLED CRITICAL NEPHROLOGIST IN CRITICAL SITUATION … and dialysis??

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