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.