CRRT

Question 1

Name the types of continous renal replacement therapies

Answer 1

CRRT- CAVHD

CVVHD

CAVH

CVVH

CAVHDF

CVVHDF

PIRRT-SLED

SLED-F

Question 2

What are the differences of C-HD, C-HF, C-HDF?

Answer 2

each is slow continous

C-HD-diffusion is the primary method of solute removal amount of UF is low

C-HF- dialysis solution is not used

large volume of replacement fluid is infused into either inflow or outflow of the line amount of fluid UF is much higher as is sum of replacement fluid and excess fluid removed

C-HDF- combination of both of above, dialysis solution and replacement fluid

Question 3

What is SCUF?

Answer 3

slow continuous ultrafiltration similar to C-HD and C- HF neither dialysis fluid or replcement fluid is used

Question 4

What is SLED and SLED-F?

Answer 4

sustained low efficiency dialysis and hemodiafiltration

IHD- extended session with low flow rates of both dialysate and blood

SLED -f requires additional fluid replacement

Question 5

Advantages of CRRT?

Answer 5

hemodynamically well tolerated, smaller change in plasma osmolality

better control of azotemia and electrolyte and aced base balance

highly effective in removing fluid( post Sx, Pulm edema, ARDS)

facitilates medication administration TPN, pressors ab, by creating unlimited sapce by continuous ultrafiltration

less effect on intracranial pressure

Question 6

filtration fraction

Answer 6

fraction of plasma flowing through the hemofilter that is removed

calculated as

UF rate/plasma flow rate

plasma flow rate= BFR*(1-Hct)

keep filtration fraction below 25% to avoid over concentration and clotting issues

Question 7

ways to keep filtration fraction below 25%

Answer 7

increase the blood flow rate

use predilution mode

Question 8

catheter placement SVC vs RA

Question 9

dosing CRRT

Answer 9

20-25ml/kg/hour KDIGO AKI 2012

Question 10

when to adjust dosing?

Answer 10

increased catabolic states

to facilitate nutritional support

in tumor lysis syndrome

for drug intoxications if can not tolerate IHD

RENAL and ATN- BUN should be less that 16 mmol/L( 45 mg/dL)

Question 11

Dosing for SLEDand SLED -F

Answer 11

no specific guidelines due to no studies KDIGO AKI reccomends weekly kt/V of 3.9 when IRRT where weekly defined as sum of treatments for each week

Question 12

six steps to estimate prescription

Answer 12

estimate or measure patients urea generation

decide on desired level of urea

calculate the total urea clearance

measure residual urea renal clearance

calculate the required drainage fluid volume if predilution used can not assume urea saturation 100 then amount of drainage volume should be increased by 10-12 %

calculate required dialysis solution replacement solution inflow rate=required drainage volume- expected removal of excess fluid

Question 13

anti coagulation

Answer 13

heparin

citrate

none

increase inflow rate

Question 14

citrate

Answer 14

chelates calcium and Mg impedes the coagulation cascade

regional anticoagulation

calcium citrate complexes are removed inthe effluent those that return to circulation are metabolize by the liver

KDIGO AKI reccomends citrate anticoagulation for CRRT

calcium is replaced by infusion of calcium post filter to patient

can result in reduction in serum ionized calicum an metabolic alkalosis

Question 15

vitamins and minerals removed in CRRT

Answer 15

active vit D,

Vit E

Vit C

zinc

selenium

copper

manganese

chromium AND THIAMINE

Question 16

indications for CRRT

Answer 16

brain edema

hypotension

large amount of fluid removal needed

ARDS

removal of immunomodulatory substances in sepsis