High-volume continuous Venovenous Hemofiltration as an effective therapy for acute management of inborn errors of metabolism in young children

Background/ Aim: Renal replacement therapies ( RRTs) have been used for the acute management of inborn errors of metabolism. Hemodialysis is the most effective modality. The aim of this article is to demonstrate that high- volume hemo-filtration can offer an alternative way to effectively remove small molecules. Methods: Eight patients presented with acute neurological deterioration due to ammonia or organic acid accumulation. Different RRTs were applied, including continuous venovenous hemofiltration ( CVVH, n = 7), continuous arteriovenous hemofiltration ( CAVH, n = 2), continuous venovenous hemodialysis ( CVVHD, n = 1), intermittent hemodialysis ( HD, n = 1), and peritoneal dialysis ( PD, n = 2). Results: Ammonia 50% reduction time in HD was 1.7 h while in CVVH it was 2 - 14.5 h. The greater the ultrafiltration flow was, the sooner patients regained consciousness. CAVH, CVVHD or PD was not sufficient enough. Conclusion: CVVH also has a good clearance for organic acid and ammonia if applying high- volume hemofiltration (> 35 ml/ kg/ h). It can be therefore be considered as an alternative therapy if infant HD is not available. Copyright (c) 2007 S. Karger AG, Basel.