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The Circuit and the Prescription 

The Circuit and the Prescription
The Circuit and the Prescription

Rinaldo Bellomo

and Ian Baldwin

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date: 20 June 2021

There is no evidence to suggest that choosing CRRT based on hemofiltration over hemodiafiltration or over hemodialysis leads to clinically important differences in outcomes. There is a clear difference, however, in terms of the nature of solute removal with convection (filtration) leading to essentially equal small solute removal but much greater middle molecular weight solute removal. It is unclear, however, whether this effect matters pathophysiologically or clinically. Because of such uncertainty, physicians and nurses choose a particular approach in a given unit (typically based on local tradition, comfort, ease of operation etc.) and apply it consistently to all patients. Epidemiological data suggest that continuous veno-venous hemodiafiltration (CVVHDF) with replacement fluid delivered in pre-dilution mode may be the most common approach to CRRT worldwide, followed by continuous veno-venous hemofiltration (CVVH) also with pre-dilution.

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