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CKD after AKI in the ICU

I give a regular talk to the residents in the ICU on CRRT and one of the things that I focus on is prognosis. We all know that the outcomes of patients requiring CRRT in the ICU are…

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When putting a patient on CRRT, the choice of buffer these days is largely dependent on whether or not you want to use citrate for anticoagulation. Most of our patients get either citrate or bicarbonate. However, not so…

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Mercury rising

A patient who had been working in a recycling company that handled thermometers presented with fever, dry cough, fatigue and rash. Based on imaging (CXR showed massive radio-opaque material in the lungs, right atrium and right ventricle; skeletal…

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Sepsis & AKI – an insoluble problem?

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Critically ill patients receiving continuous renal replacement therapy are frequently given heparin to maintain circuit patency. In the presence of active HIT-II or HITT, even in the absence of clinical thrombosis, systemic anticoagulation with a direct thrombin inhibitor…

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pre-dilutional versus post-dilutional CVVH

There are two general strategies for CVVH replacement solution entering into the blood circuit: pre-dilution (in which replacement solution is mixed with the blood prior to its entry into the filter), or post-dilution (in which replacement solution is…

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Troubleshooting CVVH

Even though most studies have not shown any mortality benefit to CVVH when compared to intermittent hemodialysis, that doesn’t mean that we don’t use CVVH all the time. At our centers (Mass General Hospital and Brigham & Women’s…

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CVVH Basics

CVVH (continuous venovenous hemodialysis) is the form of CRRT (continuous renal replacement therapy) used in our hospital. Although most studies have not shown a mortality benefit in patients treated with intermittent hemodialysis versus those treated with CVVH, in…

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