Prevention of dialysis disequilibrium by use of CVVH.

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.