1. PrismaFlex STEPP Basic CRRT Principles ®

3. Continuous Renal Replacement Therapy (CRRT) “ “ Any extracorporeal blood purification therapy intended to substitute for impaired renal function over an extended period of time and applied for or aimed at being applied for 24 hours/day.” Bellomo R., Ronco C., Mehta R, Nomenclature for Continuous Renal Replacement Therapies, AJKD, Vol 28, No. 5, Suppl 3, Nov 1996

7. R isk I njury F ailure L oss E SRD GFR Criteria Urine Output Criteria Increased creatinine x 1.5 or GFR decrease >25% UO <,0.5ml/kg/hr x 6 hours Increased creatinine x 2 or GFR decrease >50% UO <0.5 ml/kg/hr x 12 hours Increased creatinine x 3 or GFR decrease >75% or Serum Creatinine > 4mg/dl UO <0.3 ml/kg/hr x 24 hours or anuria x 12 hours Persistent ARF= complete loss of renal function >4 weeks End-stage renal disease (>3 months) Early Initiation

8. Cumulative Survival (%) vs Treatment Dose Effects of different doses in CVVH on outcome of ARF - Ronco & Bellomo study. Lancet . july 00 100 90 80 70 60 50 40 30 20 10 0 Group 1(n=146) ( Uf = 20 ml/h/Kg) Group 2 (n=139) ( Uf = 35 ml/h/Kg) Group 3 (n=140) ( Uf = 45 ml/h/Kg) 41 % 57 % 58 % p < 0.001 p n..s. p < 0.001 Survival (%)

11. CRRT Transport Mechanisms

14. Ultrafiltration Blood Out Blood In to waste (to patient) (From patient) HIGH PRESS LOW PRESS Fluid Volume Reduction

15. Molecular Weights Daltons • Inflammatory Mediators (1,200-40,000) “ small” “ middle” “ large”

17. Hemodialysis: Diffusion Dialysate In Dialysate Out (to waste) Blood Out Blood In (to patient) (from patient) HIGH CONC LOW CONC

19. Hemofiltration: Convection to waste HIGH PRESS LOW PRESS Repl. Solution Blood Out Blood In (to patient) (from patient)

22. Small vs. Large Molecules Clearance 0 20 40 60 80 100 Clearance in % 35.000 55.000 20.000 5.000 2.500 Urea (60) Albumin (66.000) Myoglobin (17.000) 65.000 Creatinine (113) Kidney Convection Diffusion

23. What is the transport mechanism associated with dialysate and replacement solutions?

24. Flow Control Unit – Pumps Effluent Pre Blood Pump Replacement: Convection Blood Dialysate: Diffusion

28. SCUF Slow Continuous UltraFiltration Effluent Pump Infusion or Anticoagulant Blood Pump PBP Pump Effluent Access Return

30. CVVHD Continuous VV HemoDialysis Hemofilter Effluent Pump Effluent Access Return Dialysate Pump Dialysate Fluid Blood Pump Infusion or Anticoagulant PBP Pump

33. CVVH Continuous VV Hemofiltration Effluent Pump Blood Pump Effluent Access Return Replacement Pump 1 Replacement Pump 2 Replacement 1 Replacement 2 Infusion or Anticoagulant PBP Pump

38. CVVHDF Continuous VV H emo D ia F iltration Effluent Pump Effluent Access Return Dialysate Pump Dialysate Fluid Blood Pump Replacement Pump Replacement Fluid PBP Pump Infusion or Anticoagulant