6 th International Conference on Pediatric Continuous Renal

6 th 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

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

Gibney N, Kimmel PL, Lazarus M, 2000

CRRT NOMENCLATURE PHYSICAL PRINCIPLE CONVECTION TREATMENT DURATION DIFFUSION (ultrafiltration) (dialysis) P A B A CONVECTION + DIFFUSION B from Ricci et al, 2009

DEFINITIONS (1) SCUF Slow Continuous Ultra. Filtration • Venovenous Circuit • Slow ultrafiltration • No substitution fluid Filtrate collecting device

DEFINITIONS (2) CVVH (postdilution) Continuous Venous Hemofiltration • Venovenous Circuit • High ultrafiltration • Substitution fluid Replacement fluid Filtrate collecting device

DEFINITIONS (3) CVVH (predilution) Continuous Venous Hemofiltration • Venovenous Circuit • High ultrafiltration • Substitution fluid Replacement fluid Filtrate Replacement fluid

DEFINITIONS (4) CVVHD Continuous Venous Hemo. Dialysis • Venovenous Circuit • Dialysate (diffusion) • Low ultrafiltration (convection) , usually BW loss • No substitution fluid Diaysate Filtrate- Dialysate

DEFINITIONS (5) CVVHDF Continuous Venous Hemo. Dia. Filtration • Venovenous Circuit • Dialysate (diffusion) • High ultrafiltration (convection) • Substitution fluid Replacement fluid Diaysate Filtrate- Dialysate

DEFINITIONS: flows in children (6) Qb: blood flow (from 10 ml/kg/min in infants to 150 -200 ml/min in adolescents) Replacement fluid Qd: dialysate flow (from 200 to 5000 ml/h) Diaysate Filtrate- Dialysate Quf: ultrafiltration rate (2000 ml/1. 73 m 2/h or? )

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 (100 -200 ml/min) • Reduced dialysate flow (100 -200 ml/min) • 10 -12 hours a day

MISCELLANEOUS TECHNIQUES: HYBRID (2) from Baldwin, 2009

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

“MAXIMAL”(? ) EFFICIENCY IN CVVH ADULT-CHILD-NEONATE K urea per liter of TBW (l/h) BW (kg) TBW (l) Qb (ml/min) UF/h (=K urea) (l/h) 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

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

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 (www. merriam-webster. com) CV DD LE H CAV S PE VH DF CRRT CH P CA VH DF CP FA CV VH D …and dialysis? ? ED HV CV D CRITICAL NEPHROLOGIST IN CRITICAL SITUATION VH CV VH DF SL HF