CONTINUOUS VENOVENOUS HEMODIAFILTRATION IN INFANTS AND CHILDREN

Continuous venovenous hemodiafiltration (CVVHD) is not commonly used i n pediatric intensive care units due to the lack of suitable equipment needed for this technique of renal replacement therapy (RRT). We have used an adapted hemodialysis machine that includes a blood pump contr oller, an air leak detector, and a venous pressure monitor over the pa st year in the pediatric intensive care unit. Blood lines available fo r hemodialysis were used for CVVHD, limiting the extracorporeal circui t volume to 38 mL, which allows for CVVHD capability in an infant as s mall as 4.5 kg without a blood-primed circuit, We have compared this e xperience to previous continuous arteriovenous hemodiafiltration (CAVH D) at our institution. The two groups (CVVHD and CAVHD) were similar i n age, weight, blood pressure, and indication for RRT. There was signi ficantly less number of hemofilters used, an improved number of hours per hemofilter, and a significantly less change of RRT modality due to ineffective dialysis (CVVHD 0% v CAVHD 32%) when using CVVHD. Further more, an average of 48% less heparin was used in the CVVHD population. We conclude that CVVHD can be safely and effectively carried out in i nfants and small children with less heparinization, no need for arteri al access, and less risk of ineffective RRT. (C) 1995 by the National Kidney Foundation, Inc.