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Crrt livertx
- 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 hemodynamic unstable patients Intermittent HD • Used as SLED
- 14. Comparison CRRT Intermittent HD • IHD looks like a rabbit • The rabbit is rapid
- 15. 100 years of service
- 16. We need both of them
- 17. Case Senario • A 56 year old gentleman • Chronic HCV, • Decompensated Liver cell failure • ? Hepatorenal syndrome Consultation
- 19. Intraoperative course • Massive blood loss: use both cell saver and compatible blood transfusion • Intraoperative hypotension • Anuria • CVP= 5-10 mmHg
- 20. CRRT Prescreption CVVHDF Blood flow: 50ml/min Dialysate=1300ml /hr Substitute= 1500ml/hr predialyser Heparin free Fluid temp.=36 Bicarb bags Modifying the drugs doses
- 21. Monitoring After one week: recovering kidney function • Good urine output and start CNI • Serum Creatinine : 2.3 mg /dl
- 22. THANK YOU