Continuous venovenous hemodiafiltration: Technical considerations
- Paul M Palevsky, MD
Paul M Palevsky, MD
- Section Editor — Renal Failure
- Professor of Medicine
- University of Pittsburgh
- VA Pittsburgh Healthcare System
The continuous renal replacement therapies (CRRTs) comprise a spectrum of treatments that include both convection-based (hemofiltration) and diffusion-based (hemodialysis) solute removal techniques [1,2]. (See "Continuous renal replacement therapies: Overview".)
Compared with intermittent therapy, 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 intermittent 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".)
CRRT techniques initially utilized arteriovenous extracorporeal circuits, in which blood flow was driven by the gradient between the mean arterial pressure and venous pressure. Continuous venovenous therapies were developed in the mid-1980s as an alternative to continuous arteriovenous hemofiltration (CAVH) and continuous arteriovenous hemodialysis (CAVHD).
The use of a pump-driven venovenous circuit permits blood flows that are both higher and more constant than provided by an arteriovenous circuit. In addition, since there is no need for a large-bore arterial catheter, the associated risks of arterial thrombosis and arterial bleeding are eliminated.
Continuous venovenous hemodiafiltration (CVVHDF) combines the convective solute removal of continuous hemofiltration with the diffusive solute removal of continuous venovenous hemodialysis (CVVHD).
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