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. 2017 Jun;40(6):257-264.
doi: 10.5301/ijao.5000610.

Continuous Renal Replacement Therapy: Forty-year Anniversary

Claudio Ronco  1   2
Affiliations

Continuous Renal Replacement Therapy: Forty-year Anniversary

Claudio Ronco. Int J Artif Organs. 2017 Jun.

Abstract

In 1977 Peter Kramer performed the first CAVH (continuous arteriovenous hemofiltration) treatment in Gottingen, Germany. CAVH soon became a reliable alternative to hemo- or peritoneal dialysis in critically ill patients. The limitations of CAVH spurred new research and the discovery of new treatments such as CVVH and CVVHD (continuous veno-venous hemofiltration and continuous veno-venous hemodialysis). The alliance with industry led to development of new specialized equipment with improved accuracy and performance in delivering continuous renal replacement therapies (CRRTs). Machines and filters have progressively undergone a series of technological steps, reaching a high level of sophistication. The evolution of technology has continued, leading to the development and clinical application of new membranes, new techniques and new treatment modalities. With the progress of technology, the entire field of critical care nephrology moved forward, expanding the areas of application of extracorporeal therapies to cardiac, liver and pulmonary support. A great deal of research made extracorporeal therapies an interesting option for the treatment of sepsis and intoxication and the additional use of sorbents was explored. With the progress in understanding the pathophysiology of acute kidney injury (AKI), new guidelines were developed, driving indications, modalities of prescription, monitoring techniques and quality assurance programs. Information technology and precision medicine have recently contributed to further evolution of CRRT, with the possibility of collecting data in large databases and evaluating policies and practice patterns. This is likely to ultimately result in improved patient care. CRRTs are 40 years old today, but they are still young and full of potential for further evolution.

Keywords: AKI; CRRT; CRRT machine; Hemofiltration; Precision CRRT; Ultrafiltration.

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Conflict of interest statement

Conflict of interest: None.

Figures

Fig. 1
Fig. 1
Timetable of the forty years of evolution in CRRT.
Fig. 2
Fig. 2
Vicenza, 1978: First CAVH treatment in an adult critically ill patient and first CAVH treatment in the world of a neonate with acute renal failure.
Fig. 3
Fig. 3
Timetable of the forty years of evolution in pediatric CRRT.
Fig. 4
Fig. 4
First CRRT treatment with CARPEDIEM (Cardio renal Pediatric Dialysis Emergency Machine).
See this image and copyright information in PMC

References

    1. Kramer P., Schrader J., Bohnsack W., Grieben G., Gröne H.J., Scheler F.. Continuous arteriovenous haemofiltration. A new kidney replacement therapy. Proc Eur Dial Transplant Assoc. 1981; 18: 743–749. - PubMed
    1. Lauer A., Saccaggi A., Ronco C., Belledonne M., Glabman S., Bosch J.P.. Continuous arterio-venous hemofiltration in the critically ill patient: Clinical Use and Operational Characteristics. Ann Intern Med. 1983; 99: 455–460. - PubMed
    1. Ricci Z., Ronco C.. Technical advances in renal replacement therapy. Semin Dial. 2011; 24(2): 138–141. - PubMed
    1. Ronco C., Garzotto F., Ricci Z. CA.R.PE.DI.E.M. (Cardio-Renal Pediatric Dialysis Emergency Machine): evolution of continuous renal replacement therapies in infants. A personal journey. Pediatr Nephrol. 2012; 27(8): 1203–1211. - PubMed
    1. Ronco C.. Arterio-venous hemodiafiltration (A-V HDF): a possible way to increase urea removal during C.A.V.H. Int J Artif Organs. 1985; 8(1): 61–62. - PubMed

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