CVVH in Europe All Sorts of Trouble and

CVVH in Europe

All Sorts of Trouble and Complications CVVH Experience in Hannover 7 -1997 to 3 -2002

CVVH Machine

Solutions for Substitution Na SH 19* 140 145 Ca 1. 63 mmol/l Lactate 36 g/l *Schiwa SH 39 Hep* mmol/l K 1 0 mmol/l 1. 55 mmol/l Mg 0. 75 0. 52 Cl 100. 75 113. 64 mmol/l 45 mmol/l Bicarbonate mmol/l Glucose 1. 96 1. 04

Patients 32 Male/ Female Age* [years] Weight* [kg] BSA [m 2] 0. 63 18 / 14 5. 3 (2 days - 19) 14. 1 (3. 3 - 88) (0. 22 - 1. 97) *median (range)

Groups of Patients Septicemia 12 Liver failure 9 Cardiac Disease 5 Renal Disease 3 Hyperammonemia 3

Solutions for Substitution Schiwa SH 39 -Hep N Schiwa SH 19 8 24

Filters Used Diafilter 20 20 Minifilter plus 4 Minifilter /D 20 5 Hemofilter 6 S 3

Blood and Dialysate Flow Blood flow [ml/kg/min] 3. 1 (0. 6 - 17. 2) Exchange rate [ml/m 2/h] 475 (189 -1505) Negative balance [ml/kg/h] 4. 2 (0 - 17)

CAVH Urea 0 1 2 4 8

Ultrafiltration

Number Filters Used

Filters clot 43/140 were lost this way (30. 3%)

Duration of CVVH and Filter Survival Total duration of CVVH [h] 56. 5 (3 - 422) Number of filters 140 „Survival“ of filter [h] 22. 4 (0. 5 - 87) Reason for loss deliberate change 44 of a filter clotting 43 operation/ CT scan 16 end of CVVH 27 technical problems 5 plasmapheresis 5

Technical Problems Switching between the 2 lines of the access 4 Necessity to replace access 2 3 Lumen oncologic catheter (Clearance 11) 1

Renal Disease (3/3) Severe Hypertension during recurrent HUS 1 Bilateral Nephrectomy during PD in an infant ATN after renal Tx 1 1

Hyperammonemia (1/3) All 3 newborns received CVVHD Defect CNS involvement Ammonia [µmol/l] Citrullinemia mild encephalopathy 842 360 Citrullinemia severe encephalopathy 802 223 CPS def. cerebral edema 900 850

Heart Disease (1/5) TGA with Rastelli operation, bradyarrhythmias Bradyarrhythmias 2 1 Pulmonary atresia with interventional opening of the outflow tract 1 Penetrating heart trauma with a bicycle 1

Liver Disease (3/9) Liver transplantation (3 acute LF) 7 Acute liver failure, no TX 2 Complicating factors Re-transplantation 2 Portal vein thrombosis 2 CNS symptoms (seizure, edema) 2 Severe rejection (plasmapheresis) 1 Destruction of liver and spleen (horse kick) 1

Septicemia(4/12) Bone Marrow. Transplant 2 Oncologic patient 2 Heart/lung. Tx in CF, Liver Tx Waterhouse-Friedrichsen Sy. , Schwachman Familial medit. Fever (amyloidosis) SCID Premature with NEC Septic RF 1 each

Causes of Death Multiple organ failure 8 Circulatory failure 4 Brain death 3 Liver failure 2 Rhabdomyolysis 2 Complete bowel necrosis 1

Major Complications Arterial hypotension 15 / 32 Bleeding 3 Thrombosis iliac vein 1

Stenosis of Internal of. Jugular the Vein Internal Jugular Vein

CAVH Results

Intensive Care and Dialysis Total Death % Cases in intensive care 938 35 LTx 15 (24), NTx 18 (31) ICU patients dialysed 24 Dialysis 24 9 38 CVVH 9 4 PD 14 5 HD 1 0 4 2. 5

Conclusion CVVH broadens the array of treatment options in acute renal failure. It allows easier management through better fluid and solute clearances. However, this does not appreciably improve survival. Still, the original disease determines the prognosis - with renal failure being an negative predictor.