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Good morning, this is Dr. Tim Bunchman,
I'm a pediatric nephrologist at Virginia Commonwealth University of Medicine.
My talk today is on CRRT,
which is Continuous Renal Replacement Therapy in children.
My talk today will talk about things relative to CRRT,
including vascular access, solutions,
anticoagulation, nutrition, drug clearance,
as well as utilization
and timing of CRRT.
To understand CRRT, one has to understand the terminology.
The concept of convection is a way (by
mass transport) to put a solution that's sterile into the vascular space
(either pre- or post-filter) and to, if you will,
'shove' the solute across the membrane by convection.
In this next slide,
we have a caricature of the same issue.
Convective clearance is called CVVH,
and you're using a physiologic sterile solution, either post-filter
(which has often happened in Australia) or
pre-filter (which happens mostly in Europe and North America) to shove,
if you will, or move solute across the membrane.
That is CVVH or convective clearance.
Diffusive clearance is that same model
but you've got dialysate on the outside of the vascular space,
setting up a gradient of which solute comes across, secondary to a gradient concept.
CVVHD, hemodialysis, peritoneal dialysis,
and a note that I don't have on this slide, SLED
(which is slower low efficiency dialysis), is all diffusion.
The concept of diffusion is that you have a sterile solution across a membrane,
across from the blood space,
that solute clears by a gradient.