Continuous arteriovenous hemodialysis: Technical considerations
- Paul M Palevsky, MD
Paul M Palevsky, MD
- Section Editor — Renal Failure
- Professor of Medicine
- University of Pittsburgh
- VA Pittsburgh Healthcare System
Continuous renal replacement therapies (CRRTs) involve either dialysis (diffusion-based solute removal) or hemofiltration (convection-based solute and water removal) treatments that operate in a continuous mode . Variations of these techniques may run 12 to 24 hours, particularly during daytime periods of full staffing.
The major advantage of continuous therapy is the slower rate of solute or fluid removal per unit of time. Thus, CRRT is generally better tolerated than conventional therapy since many of the complications of intermittent hemodialysis are related to the rapid rate of solute and fluid loss. (See "Renal replacement therapy (dialysis) in acute kidney injury (acute renal failure): Metabolic and hemodynamic considerations".)
One such technique, continuous arteriovenous hemodialysis (CAVHD), may be utilized in the treatment of acute renal failure (ARF), particularly in patients who are hemodynamically unstable and hypercatabolic. The technical aspects required to adequately perform CAVHD are reviewed here. A discussion of all CRRTs is presented separately. (See "Continuous renal replacement therapies: Overview".)
Continuous arteriovenous hemodialysis (CAVHD) was developed to augment the solute clearances obtainable with continuous arteriovenous hemofiltration (CAVH) [2,3]. Although CAVH provides excellent volume control, solute clearances are frequently insufficient to provide satisfactory control of azotemia, particularly in hypercatabolic patients. (See "Continuous renal replacement therapy in acute kidney injury (acute renal failure)".)
CAVHD is similar to CAVH with one exception: the addition of the continuous perfusion of dialysate through the hemofilter countercurrent to the direction of blood flow, most commonly at a rate of 1 to 2 L/hour (figure 1 and figure 2). As a result, the technical requirements for the satisfactory performance of CAVHD are similar to those of CAVH.
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- VASCULAR ACCESS
- Determinants of blood flow and solute removal
- OPERATIONAL CHARACTERISTICS
- Solute clearance
- DOSE OF THERAPY
- SUMMARY AND RECOMMENDATIONS