Professional Documents
Culture Documents
Stephen Lapinsky
Mount Sinai Hospital
Toronto
Objectives
CRRT: - Truths
- Unknowns
Truths regarding CRRT for AKI
Truths regarding CRRT for AKI
It is commonly used for AKI in the ICU (BEST Kidney)1
Suitable for use in hemodynamically unstable patients2
Allows precise, adaptable, volume control
Very effective control of uremia, PO4, K
Available 24 hours a day
Diffusion
13%
Intensive Care Med (2007) 33:15631570
Truths regarding CRRT for AKI
Modes of CRRT
CVVH (filtration)
predilution replacement
Convection
ultrafiltrate
1/2 of 53%
Intensive Care Med (2007) 33:15631570
Truths regarding CRRT for AKI
Modes of CRRT
CVVH (filtration)
postdilution
replacement
Convection
ultrafiltrate
1/2 of 53%
Intensive Care Med (2007) 33:15631570
Truths regarding CRRT for AKI
Hemodiafiltration
CVVHDF
dialysate
Ca citrate replacement
gluconate
ultrafiltrate
34%
Intensive Care Med (2007) 33:15631570
Unknowns regarding CRRT for AKI
Unknowns regarding CRRT for AKI
SLED
- safe, effective, cheaper than CRRT
- limited comparative data
Is it better than IHD or SLEDD?
Comparison with IHD
Uchino etet
Friedrich al,al,
Intensive
Crit Care
Care
2012;
Med16:R146
2007; 33:1563
What mode to use CVVHD or CVVH?
OMAKI study: Optimal mode of clearance in critically ill
patients with acute kidney injury
Some refinements:
- loss of efficiency with predilution
- volume of citrate anticoagulation
What dose of dialysis to use ?
45 ml/kg/hr
35 ml.kg/hr
20 ml/kr/hr