Transformation from PCRRT to PCRRT/PAKI

1. Transformation from PCRRT to PCRRT/PAKI Timothy E Bunchman Professor & Director Founder of PCRRT

2. How did PCRRT begin? • At the CRRT meeting in San Diego in 1998 the discussion started over a beer, a napkin to take notes on and a group of nurses and docs who said “why not have a Pediatric CRRT meeting?”

3. Time and Transition • 1984-Ronco’s KI paper • 1990-CAVH becomes more common • 1993-CVVH with adapted machinery • 1995-automated CVVH(D) machinery • 1997-ultrafiltration controllers with automated machinery • 1999-Thermic controls with automated machinery

4. Time and Transition • 2000-1st International Conference on Pediatric Continuous Renal Replacement Therapy • 2001-1st FDA approved Bicarbonate Based Dialysate (Normocarb) • 2001-ppCRRT Registry establishment (Stu Goldstein) • 2001-Goldstein data on FO and outcome • 2002-Citrate anticoagulation • 2002-PCRRT 2

5. Time and Transition • 2002-PEDCRRT list serve • Gambro releases Prismasate • 2003-DiCarlo data on early intervention in Bone Marrow Transplantation • 2004-Foland data on FO and outcome • 2004-Data emerging on Pharmacy Errors • 2004-PCRRT 3

6. Time and Transition • 2005 • Data on Biomarkers emerging • Work by Devarajan and colleagues • Data on citrate NDT Brophy et al • Kidney International paper confirming now with multicenter data on fluid overload • 2006 PCRRT goes to Europe! • Successful meeting in Zurich, Sw

7. Time and Transition • 2007/2008 • Hackbarth et al multicenter data vascular access • Flores et al multicenter data AKI in the BMT popultation • Gambro is allowed to release Prismaflex after embargo • PCRRT 5 • PCRRT goes to Rome!

8. Is there anything new? • At the end of the Rome meeting discussion was to stop the meeting or change its format • CRRT is no longer novel but the science of AKI is emerging at warp speed • Therefore the transition occurred!

9. Where to we go from here? • What is apparent is a need to maintain a clinical course in the practical aspects of CRRT with “hands on” SIMS options that are being offered at this course on Sunday • What is needed now is • How do we diagnose AKI that is consistent and reliable • How and when do we intervene that will effect outcome? • What can we do to increase survival rates (when they have improved dramatically in the past few decades) • What about neonates? • What about organ cross talk?

10. So • Who is here? • > 300 attendees from approximately 20 different countries • ~ 50 abstracts were submitted and will be presented over the next few days • What do we do? • Enjoy, ask questions, interact, exchange emails, • Who do we have to thank? • Industry • All companies involved with equipment were asked to come and support this meeting and demonstrate their equipment • We are appreciative to those who came to support pediatrics

11. If you need help with anything • Ask the staff, they are around and will be happy to help • Special thanks to • PCRRT Foundation • Cincinnati Children’s Hospital Medical Center Heart Institute, Center for Acute Care Nephrology & Research Foundation • Carol Malone (who has run this program for a decade and whom without her help and guidance it would not get off the ground) • Faculty who donated their time and energy for all of us

12. House keeping • There will be information between breaks and thru out the meeting on obtaining CMEs and CEUs • Please visit and talk with the industry folks • They are here to support this meeting and help make the care of children better

13. Finally • Remember….. • The smartest one in the room is the child, they are our best teachers…lets all work together for a common goal