1. 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

2. 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

3. Time and Transition 2000-1 st International Conference on Pediatric Continuous Renal Replacement Therapy 2001-Outcome studies 2001-1 st FDA approved Bicarbonate Based Dialysate 2002-Citrate anticoagulation 2002-PEDCRRT list serve

4. DIALYSIS MODALITY Belsha et al., Pediatr Nephrol, 1995 Patients (%)

5. Pediatric Choice of RRT # on RRT/yr Year of RRT

6. 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

7. 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

8. Who really does CRRT? Nursing staff of the Dialysis units- thank you Critical Care units- thank you Neonatal intensive Care units- thank you

9. 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)

10. 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

11. Who are the faculty? Peter Skippen MD Pediatric Critical Care Physician at B. C. Childrens Hospital at Vancouver, BC Kay Latta MD Pediatric Nephrologist at Kinderklinik Medizinische, Hannover, Germany

12. 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 Childrens Hospital, Houston TX

13. Who are the faculty? Bruce Bulloch MD FRCPC FAAP Pediatric Emergency Medicine Childrens Hospital of Winnipeg, Canada Patrick D Brophy MD FRCPC Pediatric Nephrologist University of Michigan, Ann Arbor MI

14. Thank you Baxter B Braun Dialysis Solution Inc Edwards Life Sciences Fresenius Gambro MedComp Inc

15. Thank you Norma J Maxvold MD Who tolerates me and gives me stability in an unstable world

16. 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

17. A few requests Fill out your evaluation cards and hand them into the desk 11 CMEs 14.7 CEUs

18. Finally Have fun and open your mind This is a therapy that is still in development, the applications of these therapies are without boundaries

19. Quote that I live by the smartest one in the room is the child