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CRRT TERMINOLOGY

6th International Conference on Pediatric C ontinuous Renal Replacement Therapy Rome,Italy. 2010, April 8-10. CRRT TERMINOLOGY. Stefano Picca, MD D ept. of Nephrology and Urology, Dialysis Unit “Bambino Gesù” Pediatric Research Hospital ROMA, Italy. CRRT modalities….

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CRRT TERMINOLOGY

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  1. 6th International Conference on Pediatric Continuous Renal Replacement Therapy Rome,Italy. 2010, April 8-10 CRRT TERMINOLOGY Stefano Picca, MD Dept. of Nephrology and Urology, Dialysis Unit “Bambino Gesù” Pediatric Research Hospital ROMA, Italy

  2. CRRT modalities… …everchanging array of names and abbreviations… …lack of standardization… creates unnecessary confusion…prevents accurate comparisons and multicenter research, and is scientifically undesirable… Bellomo, Ronco, Mehta, AJKD,1996

  3. Gibney N, Kimmel PL, Lazarus M, 2000

  4. PHYSICAL PRINCIPLE TREATMENT DURATION CRRT NOMENCLATURE CONVECTION (ultrafiltration) DIFFUSION (dialysis) P A B A B CONVECTION + DIFFUSION from Ricci et al, 2009

  5. DEFINITIONS (1) • SCUF • SlowContinuous UltraFiltration • Venovenous Circuit • Slow ultrafiltration • No substitution fluid Filtrate collecting device

  6. DEFINITIONS (2) • CVVH (postdilution) • Continuous • VenoVenous • Hemofiltration • Venovenous Circuit • High ultrafiltration • Substitution fluid Replace-ment fluid Filtrate collecting device

  7. DEFINITIONS (3) • CVVH(predilution) • Continuous • VenoVenous • Hemofiltration • Venovenous Circuit • High ultrafiltration • Substitution fluid Replace-ment fluid Filtrate Replace-ment fluid

  8. DEFINITIONS (4) • CVVHD • Continuous • VenoVenous • HemoDialysis • Venovenous Circuit • Dialysate (diffusion) • Low ultrafiltration (convection) , usually BW loss • No substitution fluid Filtrate- Diaysate Dialysate

  9. DEFINITIONS (5) • CVVHDF • Continuous • VenoVenous • HemoDiaFiltration • Venovenous Circuit • Dialysate (diffusion) • High ultrafiltration (convection) • Substitution fluid Replace-ment fluid Filtrate- Diaysate Dialysate

  10. DEFINITIONS: flows in children (6) Qb: blood flow (from 10 ml/kg/min in infants to 150-200 ml/min in adolescents) Replace-ment fluid Filtrate- Qd: dialysate flow (from 200 to 5000 ml/h) Quf: ultrafiltration rate (2000 ml/1.73 m2/h or?) Diaysate Dialysate

  11. MISCELLANEOUS TECHNIQUES: HYBRID (1) • Sustained Low Efficiency Dialysis (SLED) • Sustained Low Efficiency Daily Dialysis (SLEDD) • Prolonged Intermittent Daily RRT (PDIRRT) • Extended Dialysis (ED) • Extended Daily Dialysis (EDD) • Extended Daily Dialysis with filtration (EDDf) • In adults: • Reduced blood flow (100-200 ml/min) • Reduced dialysate flow (100-200 ml/min) • 10-12 hours a day

  12. MISCELLANEOUS TECHNIQUES: HYBRID (2) from Baldwin, 2009

  13. MISCELLANEOUS TECHNIQUES (3) • high-volume hemofiltration: • In adults, claimed to be more efficient in: • mediators removal • hemodynamics • improvement of immune • dysfunction Adapted from Ronco, 2006

  14. “MAXIMAL”(?) EFFICIENCY IN CVVHADULT-CHILD-NEONATE

  15. PUBMED, March 2010: • CVVHD-hemodiafiltration: 58 post-2000 papers • 40/58 use the acronym CVVHD incorrectly • 15/40 incorrect definition in nephrology journals • 15/40 incorrect definition in IC journals

  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) SLEDD HVHF CPFA CVVHDF CAVHDF CVVHD CRRT CAVH CHP PE …and dialysis?? CVVHDF CVVHD CAVHD CVVH SLED CRITICAL NEPHROLOGIST IN CRITICAL SITUATION

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