crrt is a RRT modality that used in liver transplantation the role of nephrologist is crucial

1. Role of CRRT in Liver
Transplantation
By
Salwa Mahmoud Elwasif, MD
Fellow of Internal Medicine and Nephrology
Mansoura Urology and Nephrology Center

2. Why?

3. Prescription
• Blood flow
• Dose
• Mode
• Substitution fluid (Predialysis or post dialysis)
• Dialysate flow
• Fluid removal
• Fluid addition
• Anticoagulation
slow

4. Prescription
• Blood flow
• Dose
• Mode
• Substitution fluid (Predialysis or post dialysis)
• Dialysate
• Fluid removal
• Fluid addition
• Anticoagulation
25ml/kg/hr.

5. Prescription
• Blood flow
• Dose
• Mode
• Substitution fluid (Predialysis or post dialysis)
• Dialysate
• Fluid removal
• Fluid addition
• Anticoagulation
SCUF, CVVHD, CVVHDF

6. Prescription
• Blood flow
• Dose
• Mode
• Substitution fluid (Predialysis or post dialysis)
• Dialysate
• Fluid removal
• Fluid addition
• Anticoagulation
Predialysis post dialysis
dilutes the blood in the
filter,
concentrates the blood
in the filter
reducing clotting. enhancing clearance

9. Prescription
• Blood flow
• Dose
• Mode
• Substitution fluid (Predialysis or post dialysis)
• Dialysate
• Fluid removal
• Fluid addition
• Anticoagulation

10. Adverse effect
• Electrolytes disturbance Risk
(required frequent monitoring)
• Bleeding versus filter clotted
• Frequent drug dose modification.

11. Comparison
CRRT
• portable
Intermittent HD
• Water supply and drain are
available
• Water treatment is not big
issue.

12. Comparison
CRRT
• It is easy to do even by
nurse
Interrupted HD
• There are many many expert
nurses

13. Comparison
CRRT
• Used in lower blood
pressure
Intermittent HD
• Used as SLED

14. Comparison
CRRT Intermittent HD
• IHD looks like a rabbit
• The rabbit is rapid
• Gradual removal of solutes

15. 100 years of service
Hospital-based
hemodialysis

16. We may need both
• Sustained low-efficiency dialysis (SLED), or extended
daily dialysis (EDD), uses the lower blood flow and
the lower dialysate flow

17. Case Scenario
• A 56 year old gentleman
• Chronic HCV,
• Decompensated Liver cell failure
• ? Hepatorenal syndrome
Consultation

18. intraoperative /postoperative

19. Intraoperative course
• Massive blood loss: use both cell saver and
compatible blood transfusion
• Intraoperative hypotension
• Anuria
• CVP= 5-10 mmHg

20. CRRT Prescription
CVVHDF
Blood flow: 50ml/min
Dialysate=1300ml /hr
Substitute= 1500ml/hr
Predialyser
Effluent fluid= 35/kg/hr

23. CRRT Prescription
CVVHDF
Blood flow: 50ml/min
Dialysate=1300ml /hr
Substitute= 1500ml/hr
predialyser
Heparin free
Fluid temp.=36
Bicarb bags
Modifying the drugs doses
Kt/v= 3.9 /wk
+ Parental nutrition

24. Monitoring
After one week:
recovering kidney function
• Good urine output and start CNI
• Serum Creatinine : 2.3 mg /dl

27. THANK YOU