Dear Tim, as far as I know this is the first patient treated with CAVH in the world. We performed this treatment in Vicenza in 1984 and the patient survived.

Dear Tim,

as far as I know this is the first patient treated with CAVH in the world. We performed this treatment in Vicenza in 1984 and the patient survived. After that we published the first series of 4 newborns treated with CAVH (Kidney

International 1986) . You made a great deal of progress since then and even more with this meeting. Best Wishes Claudio Ronco

Time and Transition

1984-Ronco’s KI paper 1990-CAVH becomes more common 1993-CVVH with adapted machinery 1995-automated CVVH(D) machinery 1997-ultrafiltration controllers with

automated machinery 1999-Thermic controls with automated

machinery

Time and Transition

2000-1st International Conference on Pediatric Continuous Renal Replacement Therapy

2001-Outcome studies 2001-1st FDA approved Bicarbonate

Based Dialysate 2002-Citrate anticoagulation 2002-PEDCRRT list serve

DIALYSIS MODALITY

0

10

20

30

40

50

60

HD PD CRRT

Belsha et al., Pediatr Nephrol, 1995

Pat

ien

ts (

%)

Pediatric Choice of RRT

0

10

20

30

40

50

60

1992 1994 1996 1998 2000 2002

PD

HD

CRRT

# o

n R

RT

/yr

Year of RRT

Why has this become common? Work in vascular access Dedicated staff who is interested in these

children Patients continue to be sicker then

historically Automated machinery has made the care

easier Anticoagulation protocols have made it easier

CRRT: Who does it?

Outside of NA > 70% of all CRRT done by non-nephrologists

Within NA USA ~ 70% done by Nephrology but

often determined by manpower Adult Nephrologists = Adult Intensivists Pediatric Nephrologists < Pediatric Intensivists

Canada ~ 50% done by Nephrology

Who really does CRRT?

Nursing staff of the

Dialysis units- thank you Critical Care units- thank you Neonatal intensive Care units- thank

you

What is the purpose of this meeting?

To bring together those in the field who deal with any modality of MOSF with RRT who are willing to listen and learn, to talk and to exchange

There are no experts in this field!! “If you quit learning then it is time to go home”

(actually he said get the hell out before you hurt someone!)

Robert Vernier MD (U of Mn, retired)

Thank you

To those of you who helped make this meeting happen Faculty Carol Malone Joni Barnett RN

PICU, dialysis and Research nurse at CHA Dialysis staff, PICU, NICU and Office of

Pediatric Nephrology at CHA

Who are the faculty?

Peter Skippen MD Pediatric Critical Care Physician at B. C.

Children’s Hospital at Vancouver, BC Kay Latta MD

Pediatric Nephrologist at Kinderklinik Medizinische, Hannover, Germany

Who are the faculty?

Timothy L Kudelka RN, BSN Pediatric Dialysis nurse (and former PCIU

nurse) at Univ of Michigan, Ann Arbor, MI Stuart L Goldstein MD

Baylor College of Medicine and Texas Children’s Hospital, Houston TX

Who are the faculty?

Bruce Bulloch MD FRCPC FAAP Pediatric Emergency Medicine Children’s

Hospital of Winnipeg, Canada Patrick D Brophy MD FRCPC

Pediatric Nephrologist University of Michigan, Ann Arbor MI

Thank you

Baxter B Braun Dialysis Solution Inc Edwards Life Sciences Fresenius Gambro MedComp Inc

Thank you

Norma J Maxvold MD Who tolerates me and gives me stability in

an unstable world

A few requests

Ask questions.. we all learn

Interact with others outside your program during the breaks, lunch

Visit the booths Learn what each machine, solution, and

access can do for your program

A few requests

Fill out your evaluation cards and hand them into the desk 11 CMEs 14.7 CEUs

Finally

Have fun and open your mind This is a therapy that is still in

development, the applications of these therapies are without boundaries

Quote that I live by

“the smartest one in the room is the child”