1. CRRT TERMINOLOGY Stefano Picca, MD
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. CRRT NOMENCLATURE P PHYSICAL PRINCIPLE TREATMENT DURATION CONVECTION
(ultrafiltration)
DIFFUSION
(dialysis)
CONVECTION +
DIFFUSION
from Ricci et al, 2009 P
A B
A B

5. DEFINITIONS (1) SCUF Slow Continuous UltraFiltration
Venovenous Circuit
Slow ultrafiltration
No substitution fluid
This method is used very rarely.
The interest is only to remove an excess of fluid and salt in the extracellular sector like in chronic congestive hart failure patients (Dr Paganini, Cleveland Clinic, USA / Dr Canaud, Montpellier, France).
Note that the TMP reached in this method does not exceed 30 mmHg (over 50 mmHg in CAVH and CVVH).
Filtrate collecting device

6. DEFINITIONS (2) CVVH (postdilution) Continuous VenoVenous
Hemofiltration
Venovenous Circuit
High ultrafiltration
Substitution fluid
Replace- ment fluid
This method is used very rarely.
The interest is only to remove an excess of fluid and salt in the extracellular sector like in chronic congestive hart failure patients (Dr Paganini, Cleveland Clinic, USA / Dr Canaud, Montpellier, France).
Note that the TMP reached in this method does not exceed 30 mmHg (over 50 mmHg in CAVH and CVVH).
Filtrate collecting device

7. DEFINITIONS (3) CVVH (predilution) Continuous VenoVenous
Hemofiltration
Venovenous Circuit
High ultrafiltration
Substitution fluid
Replace- ment fluid
This method is used very rarely.
The interest is only to remove an excess of fluid and salt in the extracellular sector like in chronic congestive hart failure patients (Dr Paganini, Cleveland Clinic, USA / Dr Canaud, Montpellier, France).
Note that the TMP reached in this method does not exceed 30 mmHg (over 50 mmHg in CAVH and CVVH).
Filtrate
Replace- ment fluid

8. DEFINITIONS (4) CVVHD Continuous VenoVenous HemoDialysis
Venovenous Circuit
Dialysate (diffusion)
Low ultrafiltration (convection) , usually BW loss
No substitution fluid
This method is used very rarely.
The interest is only to remove an excess of fluid and salt in the extracellular sector like in chronic congestive hart failure patients (Dr Paganini, Cleveland Clinic, USA / Dr Canaud, Montpellier, France).
Note that the TMP reached in this method does not exceed 30 mmHg (over 50 mmHg in CAVH and CVVH).
Filtrate-
Diaysate
Dialysate

9. DEFINITIONS (5) CVVHDF Continuous VenoVenous HemoDiaFiltration
Venovenous Circuit
Dialysate (diffusion)
High ultrafiltration (convection)
Substitution fluid
Replace- ment fluid
This method is used very rarely.
The interest is only to remove an excess of fluid and salt in the extracellular sector like in chronic congestive hart failure patients (Dr Paganini, Cleveland Clinic, USA / Dr Canaud, Montpellier, France).
Note that the TMP reached in this method does not exceed 30 mmHg (over 50 mmHg in CAVH and CVVH).
Filtrate-
Diaysate
Dialysate

10. DEFINITIONS: flows in children (6)
Qb: blood flow
(from 10 ml/kg/min
in infants to
ml/min in adolescents)
Replace- ment fluid
This method is used very rarely.
The interest is only to remove an excess of fluid and salt in the extracellular sector like in chronic congestive hart failure patients (Dr Paganini, Cleveland Clinic, USA / Dr Canaud, Montpellier, France).
Note that the TMP reached in this method does not exceed 30 mmHg (over 50 mmHg in CAVH and CVVH).
Filtrate-
Qd: dialysate flow
(from 200 to 5000 ml/h)
Diaysate
Quf: ultrafiltration rate
(2000 ml/1.73 m2/h or?)
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 ( ml/min)
Reduced dialysate flow ( 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 CVVH ADULT-CHILD-NEONATEBW
(kg)
TBW
(l) Qb
(ml/min)
UF/h
(=K urea)
(l/h)
K urea per liter of TBW
NEONATE 3
2.4 30
0.25
0.10
CHILD 25 15 80
1.2
0.08
ADULT 70 42
150
2.5
0.05

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