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Updated: Jul 14, 2026

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Published on: January 20, 2023
Prevention of dialysis disequilibrium by use of CVVH
T E Bunchman1, R M Hackbarth, N J Maxvold
1Pediatric Nephrology, DeVos Children's Hospital, Grand Rapids, MI 49503, USA. timothy.bunchman@devoschildrens.org
Objective:
Dialysis disequilibrium occurs due to a rapid shift of osmols when hemodialysis is used in cases of extreme uremia. Continuous veno-venous hemofiltration (CVVH) with citrate anticoagulation may offer a safe method of urea reduction.
Design:
Retrospective, clinical observation.
Setting:
Tertiary pediatric intensive care unit and nephrology program. Patients. Two males, ages 10 and 12 years of age.
Intervention:
CVVH with citrate anticoagulation.
Results:
Three to four day reduction of BUN from 180 mg/dL to 22 mg/dL and from 279 mg/dL to 23 mg/dL.
Conclusion:
Slow and safe improvement of severe urea, hyperphosphatemia, hypocalcemia, and anemia without untoward side effects.
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Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...