High clearance continuous renal replacement therapy with a modified dialysis machine

Abstract

High clearance continuous renal replacement therapy with a SLOW CONTINUOUS DIALYSIS modified dialysis machine. Recent studies suggest that the dial-We used a modified dialysis machine, the 2008H (Freysis dose significantly affects survival in acute renal failure senius Medical Care, Lexington, MA, USA), for SCD. (ARF) patients and that bicarbonate dialysate improves acidbase balance during continuous renal replacement therapy Special software was developed to permit dialysate flow (CRRT). These data inspired us to use slow continuous dialysis rates down to 100 ml/min (range 100 to 800 ml/min) (SCD) in the treatment of ARF. SCD is defined by the followwhile maintaining temperature control. ing parameters: (a) blood flow (Q B ) ϭ 100 to 200 ml/min, (b) Patients were treated continuously with a blood flow dialysate flow (Q D ) ϭ 100 to 300 ml/min, (c) the use of a (Q B ) of 100 to 200 ml/min and a dialysate flow (Q D ) modified hemodialysis machine with controlled ultrafiltration and online production of bicarbonate-based dialysate, and (d) of 100 ml/min. F40 or AV400S polysulfone hemofilters continuous or extended daily treatment for 8 to 24 hours. SCD (Fresenius Medical Care), each with surface areas of 0.7 provides a urea clearance in the 70 to 80 ml/min range. Prelimim 2 and standard dialysis tubing, were used. The hemonary data from an ongoing clinical trial demonstrate the safety,filter and blood lines were changed every 24 to 36 hours efficiency, and simplicity of the treatment.

Feasibility of sustained low efficiency dialysis in critically sick pediatric patients: A multicentric retrospective study

“…Prolonged Intermittent RRT (PIRRT) has been recently proposed as an umbrella term to describe any HD done for > 6 h. 4,5,[13][14][15][16] In the setting of convective clearance, the term accelerated venovenous hemofiltration has also been used. 5,6,18 It has shown good effect in treatment of multiple organ dysfunction syndrome (MODS) and acute poisonings in adults. 8,17 SLED has been primarily used as a substitute for CRRT in hemodynamically unstable critically ill adults with AKI.…”

Choice of dialysis modality for management of pediatric acute renal failure

“…Daily intermittent HD may help in this regard, but will not completely eliminate the need for fluid restriction, which in turn will frequently lead to limitations on the amount of nutritional support that a patient may receive, particularly if they are receiving large volumes of other intravenous fluids such as inotropic agents or antibiotics. (A potential method of avoiding fluid restriction is to utilize prolonged intermittent HD [56], a modality that has not yet been reported in children). Finally, the capacity of intermittent HD for ultrafiltration will be further limited if the patient is significantly hypotensive.…”

Sustained Low Efficiency Dialysis in the Continuous Mode (C-SLED)

“…Sustained (or slow) low-efficiency dialysis (SLED) benefits patients with ARF who are hemodynamically unstable (3,4). SLED is efficacious, cost effective, and easy to perform (5).…”