Transformation from PCRRT to PCRRT/PAKI Timothy E Bunchman Professor & Director Founder of PCRRT

How did PCRRT begin? At the CRRT meeting in San Diego in 1998 the discussion started over a beer, a napkin to take notes on and a group of nurses and docs who said why not have a Pediatric CRRT meeting?

Time and Transition 1984-Roncos 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 st International Conference on Pediatric Continuous Renal Replacement Therapy st FDA approved Bicarbonate Based Dialysate (Normocarb) 2001-ppCRRT Registry establishment (Stu Goldstein) 2001-Goldstein data on FO and outcome 2002-Citrate anticoagulation 2002-PCRRT 2

Time and Transition 2002-PEDCRRT list serve Gambro releases Prismasate 2003-DiCarlo data on early intervention in Bone Marrow Transplantation 2004-Foland data on FO and outcome 2004-Data emerging on Pharmacy Errors 2004-PCRRT 3

Time and Transition 2005 Data on Biomarkers emerging Work by Devarajan and colleagues Data on citrate NDT Brophy et al Kidney International paper confirming now with multicenter data on fluid overload 2006 PCRRT goes to Europe! Successful meeting in Zurich, Sw

Time and Transition 2007/2008 Hackbarth et al multicenter data vascular access Flores et al multicenter data AKI in the BMT popultation Gambro is allowed to release Prismaflex after embargo PCRRT 5 PCRRT goes to Rome!

Is there anything new? At the end of the Rome meeting discussion was to stop the meeting or change its format CRRT is no longer novel but the science of AKI is emerging at warp speed Therefore the transition occurred!

Where to we go from here? What is apparent is a need to maintain a clinical course in the practical aspects of CRRT with hands on SIMS options that are being offered at this course on Sunday What is needed now is How do we diagnose AKI that is consistent and reliable How and when do we intervene that will effect outcome? What can we do to increase survival rates (when they have improved dramatically in the past few decades) What about neonates? What about organ cross talk?

So Who is here? > 300 attendees from approximately 20 different countries ~ 50 abstracts were submitted and will be presented over the next few days What do we do? Enjoy, ask questions, interact, exchange s, Who do we have to thank? Industry All companies involved with equipment were asked to come and support this meeting and demonstrate their equipment We are appreciative to those who came to support pediatrics

If you need help with anything Ask the staff, they are around and will be happy to help Special thanks to PCRRT Foundation Cincinnati Childrens Hospital Medical Center Heart Institute, Center for Acute Care Nephrology & Research Foundation Carol Malone (who has run this program for a decade and whom without her help and guidance it would not get off the ground) Faculty who donated their time and energy for all of us

House keeping There will be information between breaks and thru out the meeting on obtaining CMEs and CEUs Please visit and talk with the industry folks They are here to support this meeting and help make the care of children better

Finally Remember….. The smartest one in the room is the child, they are our best teachers…lets all work together for a common goal