BackgroundRegional citrate anticoagulation (RCA) is one of the methods used to prevent clotting in continuous renal replacement therapy (CRRT). The aim of this study was to describe the outcomes and complications of RCA-CRRT in comparison to heparin anticoagulation (HA)-CRRT in critically ill children.MethodsThis study was a retrospective review of 30 critically ill children (16 on RCA- and 14 on HA-CRRT) who underwent at least 24 h of CRRT. The mean body weight of the children was 8.69 ± 5.63 kg. RCA-CRRT was performed with a commercially available pre-dilution citrate solution (Prismocitrate 18/0).ResultsThe mean time on RCA-CRRT and HA-CRRT was 148.73 ± 131.58 and 110.24 ± 105.38 h, respectively. Circuit lifetime was significantly higher in RCA-CRRT than in HA-CRRT (58.04 ± 51.18 h vs. 37.64 ± 32.51 h, respectively; p = 0.030). Circuit clotting was observed in 11.63 % of children receiving RCA-CRRT and 34.15 % of those receiving HA-CRRT. Episodic electrolyte and metabolic disturbances were more common in children receiving RCA-CRRT. The survival at discharge from the hospital was 37.5 and 14.3 % among children receiving RCA-CRRT and HA-CRRT, respectively.ConclusionsIn critically ill children with a low body weight, RCA appeared to be safe and easy to used. Among our patient cohort, RCA was more effective in preventing circuit clotting and provided a better circuit lifetime than HA.

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Introduction: Primary hypertension (PHT) has long ceased to be an adult problem. It commonly affects children and adolescents and is becoming a severe health care problem in many countries. In contrast to secondary hypertension, which occurs mainly in younger children with kidney, cardiovascular, and endocrine disorders, PHT affects older children and adolescents. Potential causes of PHT include being overweight, particularly obese, sleep apnea, and increased sympathetic nervous system (SNS) activity. Vegetative system activity is an essential factor in children's blood pressure (BP). Those with excessive sympathetic system activity have increased heart rate, BP, and other parameters characterizing the positive chronotropic effect. In turn, one of the factors stimulating the SNS is blood desaturation (DES). This study investigates the relationship between ambulatory BP and oxygen DES rates. Material and methods:The degree and number of DES episodes were assessed by finger pulse oximetry during 24-h ambulatory monitoring in 54 boys and girls with PHT. Their results were compared to 52 healthy children without PHT. Results: Several disturbances in blood saturation were found in children with PHT. They had more episodes of DES and profound hypoxia (< 90%), their blood DES was significantly lower, and their DES time was longer. Additionally, higher systolic BP and higher diastolic pressure loads were observed throughout the day and night in children with longer DES times (> 60 s), who also had more DES episodes and lower baseline and average blood saturation. Conclusions: Children with PHT show significant disturbances in blood oxygenation, leading to overactive SNS activity, which may be a crucial element in PHT pathogenesis in children.