Normally a continuous therapy, but may be unavoidably interrupted – for example, due to bag and filter changes, surgery, CT scans etc.
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 CVVHDF contributes to better filter potency. Pure post CVVH would require high blood flows to limit hemoconcentration, which practically can be difficult to realize
multiFiltrate Ci-Ca EMiC2
When Ci-Ca and EMiC2 are combined the patient benefits from an established Ci-Ca CVVHD protocol as well as an increased middle-molecule clearance.
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)
CVVH is a convection based therapy. Blood is pumped through the blood compartment of the filter and a significant filtrate flow is produced by action of the filtrate pump. This filtrate flow requires compensation by infusion of a substitution fluid to the blood flow pre- or post-filter. This way, high filtrate flows can be generated which enhances solute removal.
Continuous Veno-Venous Hemofiltration in post-dilution (Post-CVVH)
Continuous Veno-Venous Hemofiltration in pre-dilution (Pre-CVVH)
Continuous Veno-Venous Hemofiltration in pre-and postdilution (Pre-Post CVVH)
Continuous Veno-Venous Hemodiafiltration (CVVHDF)
CVVHDF combines the use of both, diffusion and convection therapies. 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 diffusive clearances. In addition, a substitution fluid is infused into the blood flow either pre- or post-filter. This is paralleled by filtration of plasma water across the membrane resulting in convective clearance.
Continuous Veno-Venous Hemodiafiltration in predilution (Pre-CVVHDF)
Continuous Veno-Venous Hemodiafiltration in postdilution (Post-CVVHDF)