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Controversy in Nephrology: Has Continuous Kidney Replacement Failed Its Promise?

  • 1 Richard A. Lafayette, MD, is Professor, Medicine (Nephrology) at Stanford University Medical Center. References
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More than 35 years ago, continuous arteriovenous hemofiltration (CAVH) was introduced by Kramer and colleagues (1) in order to optimize volume in hemodynamically compromised individuals with insufficient urine output. The successful treatment of congestive heart failure, despite cardiogenic shock, was heralded as a major advance, but soon limitations in solute clearance and complications of critical limb ischemia had clinicians looking for better solutions. This ushered in an era of multiple continuous dialytic techniques, including slow continuous ultrafiltration (SCUF), continuous venovenous hemofiltration (CVVH), continuous venovenous hemodiafiltration (CVVHDF), and sustained low-efficiency dialysis (SLED), which have become commonplace in intensive care

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