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Abstract: FR-PO452

Accelerated Venovenous Hemofiltration (AVVH): Piloting a Transitional Renal Replacement Therapy in the Intensive Care Unit

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Endres, Paul, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Parris, Tyler, BWH/MGH, Boston, Massachusetts, United States
  • Zhao, Sophia, Massachusetts General Hospital, Boston, Massachusetts, United States
  • May, Megan Fitzmaurice, BWH/MGH, Boston, Massachusetts, United States
  • Sylvia-Reardon, Mary H., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Bezreh, Nicole, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Culbert-Costley, Roberta L., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Ananian, Lillian, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Roberts, Russel Joseph, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Lopez, Natasha, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Charytan, David M., New York University School of Medicine, Bronx, New York, United States
  • Tolkoff-Rubin, Nina E., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Allegretti, Andrew S., Massachusetts General Hospital, Boston, Massachusetts, United States
Background

The need for continuous renal replacement therapy (CRRT) is associated with high mortality and resource use in the ICU. There are no guidelines establishing optimal timing of transition from CRRT to intermittent hemodialysis (iHD). AVVH is a form of CRRT that allows for higher blood flows, increased hemofiltration rates, no anticoagulation, and a 10 hour treatment period, as a transition between CRRT and iHD, and assessed treatment characteristics.

Methods

Quality improvement pilot aimed to achieve a safe and effective transition between CRRT and iHD using AVVH at large academic medical center between October 2017 and August 2018. AVVH treatment doses, blood flows, clearances, filter clotting, and patient outcomes were recorded.

Results

51 patients received a total of 142 complete AVVH treatments. 11 (8%) patient treatments were not completed due to inadequate blood flows (3), filter clotting (7), and change to comfort measures (1). Average prescription was: treatment time 9.3 (± 1.6) hours, blood flow 350 (± 22) mL/min, replacement fluid rate 4.1 (± 0.3) L/hr, ultrafiltration volume 2.0 (± 1.1) L/treatment, urea reduction ratio 28 (± 17)%/10 hrs. 32/51 (69%) patients received sequential daily treatments (range 2-13 treatments). In-patient mortality was 31%, length of stay 53 (± 49) days. 36/51 (70%) patients successfully transitioned to iHD, 10/51 patients (20%) recovered renal function after AVVH, and 4/46 (8%) patients required readmission to the ICU after developing hypotension on iHD.

Conclusion

AVVH was successfully integrated into our ICU program as an innovative transition therapy between CRRT and iHD. It has tremendous potential to reduce ICU readmission and healthcare costs. Further study is needed to determine its impact on resource utilization and patient outcomes.

Patient Characteristics
AKI Cases44 (86%)
Age (years)61 (±15)
Apache Score25 (±7)
Use of Vasopressors43 (30%)
In-Hospital Mortality16 (31%)
Pre-AVVH BUN (mg/dL)44 (±17)
Post-AVVH BUN (mg/dL)31 (±14)