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History and development of continuous renal replacement techniques
1Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin Georg-August-University, Göttingen, Germany. hburcha@gwdg.de
Kidney International. Supplement
|May 9, 1998
Summary
Hemofiltration, a convective renal replacement technique, evolved from early membranes to continuous arteriovenous hemofiltration (CAVH) and later CVVH and hemodiafiltration for acute renal failure.
Area of Science:
- Nephrology
- Biomedical Engineering
Background:
- Early research in the 1960s focused on high-flux membranes for renal replacement.
- Advancements in understanding membrane transport mechanisms paralleled membrane development.
Observation:
- The term "hemofiltration" was coined in 1976, followed by the first multicenter trial for chronic renal failure.
- Continuous arteriovenous hemofiltration (CAVH) was developed in 1977, offering technical simplicity and hemodynamic stability for critically ill patients.
- CAVH's limitations in toxin removal and arterial access complications spurred the development of venovenous pump-driven hemofiltration (CVVH).
Findings:
- Continuous venovenous hemofiltration (CVVH) improved upon CAVH by eliminating dependence on systemic circulation and arterial access.
- Combining hemofiltration's convection with dialysis's diffusion (hemodiafiltration) significantly enhanced solute clearance.
- Modern hemodiafiltration is the most effective renal replacement therapy for acute renal failure in intensive care settings.
Implications:
- The evolution of hemofiltration techniques has led to more effective and safer renal replacement therapies.
- These advancements are crucial for managing acute renal failure in critically ill patients.
- Continued innovation in renal replacement therapy optimizes patient outcomes and addresses limitations of earlier methods.