Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Continuous venovenous hemodiafiltration: Technical considerations

Paul M Palevsky, MD
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD


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: 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).

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jan 27, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Manns M, Sigler MH, Teehan BP. Continuous renal replacement therapies: an update. Am J Kidney Dis 1998; 32:185.
  2. Mehta RL. Continuous renal replacement therapy in the critically ill patient. Kidney Int 2005; 67:781.
  3. Brunet S, Leblanc M, Geadah D, et al. Diffusive and convective solute clearances during continuous renal replacement therapy at various dialysate and ultrafiltration flow rates. Am J Kidney Dis 1999; 34:486.
  4. Troyanov S, Cardinal J, Geadah D, et al. Solute clearances during continuous venovenous haemofiltration at various ultrafiltration flow rates using Multiflow-100 and HF1000 filters. Nephrol Dial Transplant 2003; 18:961.
  5. Friedrich JO, Wald R, Bagshaw SM, et al. Hemofiltration compared to hemodialysis for acute kidney injury: systematic review and meta-analysis. Crit Care 2012; 16:R146.
  6. Hoffmann JN, Hartl WH, Deppisch R, et al. Hemofiltration in human sepsis: evidence for elimination of immunomodulatory substances. Kidney Int 1995; 48:1563.
  7. Kellum JA, Johnson JP, Kramer D, et al. Diffusive vs. convective therapy: effects on mediators of inflammation in patient with severe systemic inflammatory response syndrome. Crit Care Med 1998; 26:1995.
  8. Sanchez-Izquierdo JA, Perez Vela JL, Lozano Quintana MJ, et al. Cytokines clearance during venovenous hemofiltration in the trauma patient. Am J Kidney Dis 1997; 30:483.
  9. Sieberth HG, Kierdorf HP. Is cytokine removal by continuous hemofiltration feasible? Kidney Int Suppl 1999; :S79.
  10. De Vriese AS, Colardyn FA, Philippé JJ, et al. Cytokine removal during continuous hemofiltration in septic patients. J Am Soc Nephrol 1999; 10:846.
  11. Roberts M, Winney RJ. Errors in fluid balance with pump control of continuous hemodialysis. Int J Artif Organs 1992; 15:99.
  12. Ifediora OC, Teehan BP, Sigler MH. Solute clearance in continuous venovenous hemodialysis. A comparison of cuprophane, polyacrylonitrile, and polysulfone membranes. ASAIO J 1992; 38:M697.
  13. Relton S, Greenberg A, Palevsky PM. Dialysate and blood flow dependence of diffusive solute clearance during CVVHD. ASAIO J 1992; 38:M691.
  14. Johnston RV, Boiteau P, Charlebois K, et al. Responding to tragic error: lessons from Foothills Medical Centre. CMAJ 2004; 170:1659.
  15. Culley CM, Bernardo JF, Gross PR, et al. Implementing a standardized safety procedure for continuous renal replacement therapy solutions. Am J Health Syst Pharm 2006; 63:756.
  16. Uchino S, Fealy N, Baldwin I, et al. Pre-dilution vs. post-dilution during continuous veno-venous hemofiltration: impact on filter life and azotemic control. Nephron Clin Pract 2003; 94:c94.
  17. Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet 2000; 356:26.
  18. Bouman CS, Oudemans-Van Straaten HM, Tijssen JG, et al. Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective, randomized trial. Crit Care Med 2002; 30:2205.
  19. Tolwani AJ, Campbell RC, Stofan BS, et al. Standard versus high-dose CVVHDF for ICU-related acute renal failure. J Am Soc Nephrol 2008; 19:1233.
  20. RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med 2009; 361:1627.
  21. VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 2008; 359:7.
  22. http://www.kdigo.org/clinical_practice_guidelines/pdf/KDIGO%20AKI%20Guideline.pdf.