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CRRT
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- 2. Continuous Renal Replacement Therapy By SalwaMahmoud Elwasif, MD Renal Transplantation and Hemodialysis Unit
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- 4. Indications of CRRT: •Indications of hemodialysis • Indications of choosing CRRT K ? acidosis
- 6. Prescription • Blood flow •Dose • Mode • Substitution fluid (Predialysis or post dialysis) • Dialysate flow • Fluid removal • Fluid addition • Anticoagulation slow
- 7. Prescription • Blood flow •Dose • Mode • Substitution fluid (Predialysis or post dialysis) • Dialysate • Fluid removal • Fluid addition • Anticoagulation 25ml/kg/hr.
- 8. Prescription • Blood flow •Dose • Mode • Substitution fluid (Predialysis or post dialysis) • Dialysate • Fluid removal • Fluid addition • Anticoagulation SCUF, CVVHD, CVVHDF
- 9. 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
- 12. Prescription • Blood flow •Dose • Mode • Substitution fluid (Predialysis or post dialysis) • Dialysate • Fluid removal • Fluid addition • Anticoagulation
- 14. Adverse effect • Electrolytesdisturbance Risk (required frequent monitoring) • Bleeding versus filter clotted • Frequent drug dose modification.
- 15. Comparison CRRT • portable Intermittent HD •Water supply and drain are available • Water treatment is not big issue.
- 16. Comparison CRRT • It iseasy to do even by nurse Interrupted HD • There are many many expert nurses
- 17. Comparison CRRT • Used inhemodynamic unstable patients Intermittent HD • Used as SLED
- 21. Comparison CRRT Intermittent HD •Expensive • Not always available • Not suitable for urgent indications
- 22. Comparison CRRT Intermittent HD •IHD looks like a rabbit • The rabbit is rapid
- 23. 100 years ofservice
- 24. We need bothof them
- 25. Case scenario • A72 years gentleman • Solitary left kidney (right was nephrectomized since 1990) • Bronchopneumonia, hypoxemia • Disturbed conscious level • AKI on top of CKD (serum Cr. =9.5mg/dl ) • Blood pressure maintained on noradrenaline iv infusion.
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- 29. Prescription • Blood flow(titrated up to 200ml/min) • Dose (25x80=2000ml/hr.) • Mode CVVHDF • Substitution fluid (Predialysis or post dialysis) • Dialysate flow • Fluid removal ( fluid intake-insensible loss) • Fluid addition • Anticoagulation (heparin infusion 400IU/hr)