BUMC Basics.pdf - Anesthesia Home

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fluid pulled off and into the peritoneum. Access is through a
temporary or permanent catheter.
Choice of therapy:
• Continuous Renal Replacement Therapy (CRRT):
-Continuous venovenous hemodialysis (CVVHD)
-Continuous arteriovenous hemodialysis (CAVHD)
-Continuous venovenous hemodialysis with filtration
(CVVHDF)
-Continuous arteriovenous hemodialysis with filtration
(CAVHDF)
-Continuous venovenous hemofiltration (CVVHF)
-Continuous arteriovenous hemofiltration (CAVHF)
• Intermittent Hemodialysis (IDH)
• Peritoneal Dialysis (PD)
Timing of therapy: Optimal timing of RRT in patients with
AKI remains to be clearly elucidated. Some retrospective and
uncontrolled studies suggest that prophylactic dialysis prior to
the development of overt uremia among patients with
progressive AKI may be associated with reduced mortality.
Some show no difference in mortality. Only one prospective
randomized trial has been done to evaluate the timing of
CRRT and it showed no survival benefit in early versus late
CVVHF. Timing is therefore very much practitioner based.
Choice of modality:
• Hemofiltration versus hemodialysis: HF can more quickly
clear larger molecular weight molecules. However, no trials
have shown improved clinical outcomes with either modality
over the other.
• CRRT versus IHD: Current data suggests that survival and
renal recovery are equal in patients who undergo CRRT versus
IHD. Data do not support the superiority of any particular
mode of RRT in patients with AKI.