ONLINE CONTINUOUS VENOVENOUS HEMODIAFILTRATION - A TECHNIQUE FOR THE CONTROL OF ULTRAFILTRATION AND CONVECTION DURING CONTINUOUS RENAL REPLACEMENT THERAPY

Continuous renal replacement therapies have been used increasingly in critically ill patients in nephrologic and intensive care units. These techniques are nevertheless time consuming and lack an easy control o f ultra filtration. We conducted continuous venovenous hemodialysis (C VVHD) on a dialysate delivery machine which ensures a volumetric contr ol of ultrafiltration, and which produces both dialysate and infusate with the on-line technique. This new mode of CVVHD was firstly assesse d in a feasibility study and was secondly used in a randomized prospec tive study whose goal was to establish the usefulness of convection. O n-line continuous venovenous hemodiafiltration (OL-CVVHDF) appeared sa fe and time saving, and allowed the fine control of fluid management i n critically ill patients. Convective transfers were achieved by a 2 L /h predilutional infusion and increased urea and creatinine clearances twofold. OL-CVVHDF revealed itself to be a valuable method for the co ntrol of ultrafiltration and for efficient convective transfers during CVVHD.