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Continuous renal replacement therapy (CRRT) set-ups

Nurse operating a multiFiltrate machine

Different options as standard therapies for acute kidney injury (AKI)

  • Continuous veno-venous hemodialysis (CVVHD)
  • Continuous veno-venous hemofiltration (CVVH) 
  • Continuous veno-venous hemodiafiltration (CVVHDF)

CRRT at a glance

post-dilution CVVHDF

Advantageous CRRT variants: CVVHD and post-dilution CVVHDF

  • CVVHD and post CVVHDF enable efficient use of CRRT-fluid. Any predilution would dilute uremic toxins and reduce efficacy of CRRT-fluid usage
  • Minimal or limited hemoconcentration with CVVHD and post CVVHD contributes to better filter potency. Pure post CVVH would require high blood flows to limit hemoconcentration, which practically can be difficult to realize

 

 

 

Continuous veno-venous hemodialysis (CVVHD) 

Continuous Veno-Venous Hemodialysis (CVVHD)
Continuous Veno-Venous Hemodialysis (CVVHD)

CVVHD is a diffusion based therapy. Blood is pumped through the blood compartment of the filter and dialysate flows counter-currently. The counter-current flow optimizes the diffusion gradient and, thus the resulting clearances. Practically with CVVHD, dialysate flow is clearly smaller than the blood flow, corresponding to clearances closely related to dialysate flow.

Continuous veno-venous hemofiltration (CVVH) 

Continuous veno-venous hemodiafiltration (CVVHDF)

CRRT vs. iHD

SLEDD

The advantages of CRRT and iHD

Study results - better recovery of renal function with CRRTLimited duration of anticoagulation, maybe treatment feasible without anticoagulation

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Related Content 

1 Bell M et al., Intensive Care Medicine (2007); 33: 773-780 

2 Uchino et al, The International journal of Artificial Organs (2007); 30: 281-292

3 Lin YF et al, The American Journal of Surgery (2009); 198: 325-332

4 Schneider AG et al., Intensive Care Medicine (2013); 39: 987-997 

5 Wald R et al., Critical Care Medicine (2014); 42: 868-876

6 Bellomo R & Schneider AG, Critical Care Medicine (2014); 42: 990-991