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  1. 1. Welcome from PCRRT Foundation, Inc &
  2. 2. Dear Tim, as far as I know this is the first patient treated with CAVH in the world. We performed this treatment in Vicenza in 1984 and the patient survived. After that we published the first series of 4 newborns treated with CAVH (Kidney International 1986) . You made a great deal of progress since then and even more with this meeting. Best Wishes Claudio Ronco
  3. 3. Time and Transition <ul><li>1984-Ronco’s KI paper </li></ul><ul><li>1990-CAVH becomes more common </li></ul><ul><li>1993-CVVH with adapted machinery </li></ul><ul><li>1995-automated CVVH(D) machinery </li></ul><ul><li>1997-ultrafiltration controllers with automated machinery </li></ul><ul><li>1999-Thermic controls with automated machinery </li></ul>
  4. 4. Time and Transition <ul><li>2000-1 st International Conference on Pediatric Continuous Renal Replacement Therapy </li></ul><ul><li>2001-1 st FDA approved Bicarbonate Based Dialysate (Normocarb) </li></ul><ul><li>2001-ppCRRT Registry establishment (Stu Goldstein) </li></ul><ul><li>2001-Goldstein data on FO and outcome </li></ul><ul><li>2002-Citrate anticoagulation </li></ul><ul><li>2002-PCRRT 2 </li></ul>
  5. 5. Time and Transition <ul><li>2002-PEDCRRT list serve </li></ul><ul><li>Gambro releases Prismasate </li></ul><ul><li>2003-DiCarlo data on early intervention in Bone Marrow Transplantation </li></ul><ul><li>2004-Foland data on FO and outcome </li></ul><ul><li>2004-Data emerging on Pharmacy Errors </li></ul><ul><li>2004-PCRRT 3 </li></ul>
  6. 6. Time and Transition <ul><li>2005 </li></ul><ul><ul><li>Data on Biomarkers emerging </li></ul></ul><ul><ul><ul><li>Work by Devarajan and colleagues </li></ul></ul></ul><ul><ul><li>Data on citrate NDT Brophy et al </li></ul></ul><ul><ul><li>Kidney International paper confirming now with multicenter data on fluid overload </li></ul></ul><ul><li>2006 PCRRT goes to Europe! </li></ul><ul><ul><li>Successful meeting in Zurich, Sw </li></ul></ul>
  7. 7. Time and Transition <ul><li>2007/2008 </li></ul><ul><ul><li>Hackbarth et al multicenter data vascular access </li></ul></ul><ul><ul><li>Flores et al multicenter data AKI in the BMT popultation </li></ul></ul><ul><ul><li>Gambro is allowed to release Prismaflex after embargo </li></ul></ul><ul><ul><li>PCRRT 5 </li></ul></ul>
  8. 8. DIALYSIS MODALITY Belsha et al., Pediatr Nephrol, 1995 Patients (%)
  9. 9. Pediatric Choice of RRT # on RRT/yr Year of RRT
  10. 10. Why has this become common? <ul><li>Work in vascular access </li></ul><ul><li>Dedicated staff who is interested in these children </li></ul><ul><li>Patients continue to be sicker then historically </li></ul><ul><li>Automated machinery has made the care easier </li></ul><ul><li>Anticoagulation protocols have made it easier </li></ul>
  11. 11. CRRT: Who does it? <ul><li>Outside of NA > 70% of all CRRT done by Intensivists </li></ul><ul><li>Within NA </li></ul><ul><ul><li>USA ~ 60% done by Nephrology but often determined by manpower </li></ul></ul><ul><ul><ul><li>Adult Nephrologists = Adult Intensivists </li></ul></ul></ul><ul><ul><ul><li>Pediatric Nephrologists < Pediatric Intensivists </li></ul></ul></ul><ul><ul><li>Canada ~ 50% done by Nephrology </li></ul></ul>
  12. 12. Who really does CRRT? <ul><li>Nursing staff of the </li></ul><ul><li>Dialysis units- thank you </li></ul><ul><li>Critical Care units- thank you </li></ul><ul><li>Neonatal intensive Care units- thank you </li></ul>
  13. 13. What is the purpose of this meeting? <ul><li>To bring together those in the field who deal with any modality of MOSF with RRT who are willing to listen and learn, to talk and to exchange </li></ul><ul><li>There are no experts in this field!! </li></ul><ul><li>“If you quit learning then it is time to go home” </li></ul><ul><ul><li>(actually he said get the hell out before you hurt someone!) </li></ul></ul><ul><ul><ul><li>Robert Vernier MD (U of Mn, retired) </li></ul></ul></ul>
  14. 14. Thank you <ul><li>To those of you who helped make this meeting happen </li></ul><ul><ul><li>Faculty </li></ul></ul><ul><ul><li>Carol Malone </li></ul></ul><ul><ul><ul><li>Program and Meeting planner </li></ul></ul></ul><ul><ul><li>Stacey Hunt </li></ul></ul><ul><ul><ul><li>Administer of my division who keeps me organized </li></ul></ul></ul><ul><ul><li>PCRRT Organizing committee </li></ul></ul><ul><ul><li>PCRRT Foundation, Inc </li></ul></ul>
  15. 15. Who are the faculty? <ul><li>Jim Fortenberry MD </li></ul><ul><ul><li>Director of Pediatric Critical Care at Eggleston Childrens Hospital in Atlanta, GA USA </li></ul></ul><ul><li>Stefano Picca MD </li></ul><ul><ul><li>Pediatric Nephrologist @Bambino Gesu Children’s research Hospital, Rome, Italy </li></ul></ul>
  16. 16. Who are the faculty? <ul><li>Helen Currier BSN, RN, CNN </li></ul><ul><ul><li>Clinical Program Specialist Texas Children’s Hospital, Houston TX </li></ul></ul><ul><li>Stuart L Goldstein MD </li></ul><ul><ul><li>Pediatric Nephrology @ Baylor College of Medicine & Texas Children’s Hospital, Houston TX </li></ul></ul>
  17. 17. Who are the faculty? <ul><li>Jordan Symons MD </li></ul><ul><ul><li>Pediatric Nephrology @ Univ of Washington, Children’s Hospital of Seattle, Seattle, Wa </li></ul></ul><ul><li>Patrick D Brophy MD FRCPC </li></ul><ul><ul><li>Associate Professor & Director Pediatric Nephrologist University of Iowa, Iowa City, IA </li></ul></ul>
  18. 18. Who are the faculty? <ul><li>Prasad Devarajan MD </li></ul><ul><ul><li>Professor and Director Pediatric Nephrology Cincinnati Children’s Hospital, Cincinnati, OH </li></ul></ul><ul><li>Dawn Eding RN </li></ul><ul><ul><li>Pediatric Critical Care Nurse and Coordinator of CRRT program, Helen DeVos Children’s Hospital, Grand Rapids, MI </li></ul></ul>
  19. 19. Who are the faculty? <ul><li>Maricor Grio MD </li></ul><ul><ul><li>Pediatric Nephrology Arnold Palmer Children’s Hospital, Orlando, FL </li></ul></ul><ul><li>Rick Hackbarth MD </li></ul><ul><ul><li>Pediatric Critical Care and Associate Professor Helen DeVos Children’s Hospital, Grand Rapids, MI </li></ul></ul>
  20. 20. Who are the faculty? <ul><li>Morgan R. Cole, Pharm.D., BCPS </li></ul><ul><ul><li>Manager, Helen DeVos Children's Hospital Pharmacy Services, Grand Rapids, MI </li></ul></ul><ul><li>Michael Zappitelli MD, MSc </li></ul><ul><ul><li>Assistant Professor Pediatric Nephrology Montreal Children’s Hospital & McGill University, Montreal Canada </li></ul></ul>
  21. 21. What is in the bag? <ul><li>CDR with all talks </li></ul><ul><li>CDR also has an updated list of references as well as heparin and citrate protocols </li></ul><ul><li>Pens and paper from Industry </li></ul>
  22. 22. <ul><li>Gambro </li></ul><ul><li>ICU Medical </li></ul><ul><li>MedComp </li></ul><ul><li>Medigroup, Inc. </li></ul><ul><li>NxStage </li></ul><ul><li>Covidien </li></ul><ul><li>B. Braun Medical, Inc. </li></ul><ul><li>Dialysis Solutions, Inc. </li></ul><ul><li>Baxter Health Care </li></ul><ul><li>Fresenius Medical, Inc. </li></ul><ul><li>Roche </li></ul>Thanks to our Supporters
  23. 23. What is new this time? <ul><li>Expansion of </li></ul><ul><ul><li>Workshops on Nursing by request </li></ul></ul><ul><ul><li>Workshops by Industry by request </li></ul></ul><ul><ul><li>Workshops on Drug monitoring by request </li></ul></ul><ul><ul><li>Workshops on Nutrition by request </li></ul></ul><ul><li>Session on Biomarkers </li></ul><ul><li>Session on Infants and Neonates </li></ul>
  24. 24. Who are the Audience <ul><li>21 abstracts were submitted from 9 separate countries </li></ul><ul><li>50% make up of Nursing </li></ul><ul><li>45% physician </li></ul><ul><li>5% pharmacist </li></ul>
  25. 25. A few requests <ul><li>Ask questions.. </li></ul><ul><ul><li>we all learn </li></ul></ul><ul><li>Interact with others outside your program during the breaks, lunch </li></ul><ul><li>Visit the booths </li></ul><ul><ul><li>learn what each machine, solution, and access can do for your program </li></ul></ul>
  26. 26. A few requests <ul><li>Fill out your evaluation cards and hand them into the desk </li></ul><ul><ul><li>14 CMEs </li></ul></ul><ul><ul><li>15 CEUs </li></ul></ul>
  27. 27. Finally <ul><li>Have fun and open your mind </li></ul><ul><li>This is a therapy that is still in development, the applications of these therapies are without boundaries </li></ul><ul><li>If Carol Malone, Stacey Hunt or I can help you in any way please do not hesitate to ask </li></ul>
  28. 28. Quote that I live by <ul><li>“the smartest one in the room is the child” </li></ul>