Acute dialysis in children: results of a European survey

Guzzo, Isabella; Galasso, Lara De; Mır, Sevgı; Bulut, İpek Kaplan; Jankauskienė, Augustina; Burokiene, Vilmanta; Cvetković, Mirjana; Kostić, Mirjana; Bayazıt, Aysun Karabay; Yıldızdaş, Dinçer; Schmitt, Claus Peter; Paglialonga, Fabio; Montini, Giovanni; Yılmaz, Ebru; Oh, Jun; Weber, Lutz T.; Taylan, Christina; Hayes, Wesley; Shroff, Rukshana; Vidal, Enrico; Murer, Luisa; Mencarelli, Francesca; Pasini, Andrea; Teixeira, Ana; Afonso, Alberto Caldas; Drożdż, Dorota; Schaefer, Franz; Picca, Stefano

doi:10.1007/s40620-019-00606-1

Cited by 27 publications

(17 citation statements)

References 30 publications

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“…In European countries, PD and continuous renal replacement therapy (CRRT) are utilized in equal proportions for acute dialysis accounting for 39.4% and 38.2% of treatments, respectively, while in North America CRRT is the predominant modality utilized. 16 SA-AKI, underlying CKD with pyogenic infections, malaria, severe dengue, acute tubular necrosis, and glomerulonephritis were the underlying diagnoses in our critically ill patients requiring acute dialysis. Renal malformations are one of the most common causes of CKD in India, 17 hence it constituted significant proportions of our patients with acute dialysis.…”

Section: Discussionmentioning

confidence: 87%

Peritoneal dialysis in critically ill children in resource-limited setting: A prospective cohort study

et al. 2020

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Background: Peritoneal dialysis (PD) is easily available and simple lifesaving procedure in children with renal impairment. There is paucity of reports on efficacy of PD in critically ill children in presence of shock and those requiring mechanical ventilation. Methods: In this prospective observational study, efficacy and outcome of PD were evaluated in 50 critically ill children aged 1 month to 14 years admitted in pediatric intensive care unit of a tertiary care teaching hospital in India. Results: Indication of PD was acute kidney injury (AKI) in 66% of patients followed by chronic kidney disease with acute deterioration due to infectious complications in 34%. Bacterial sepsis was the most common cause of AKI (22%), others being malaria (14%) and severe dengue (12%). At initiation of PD, 26% of patients were in shock and 46% were mechanically ventilated. PD was effective and improvement in pH, bicarbonate, and lactate started within hours, with consistent improvement in estimated glomerular filtration rate by 24 h, which continued till the end of procedure, including the subgroup of patients with shock and mechanical ventilation. Total complications were seen in 14% and of which peritonitis was present in 4.0% of patients. Mortality was seen in 14% (7/50) of patients. Shock at initiation of PD (odds ratio (OR), 5.03; 95% confidence interval (CI), 0.95–26.69; p < 0.04) and requirement of mechanical ventilation (OR, 9.17; 95% CI, 1.01–83.10; p < 0.02) were associated with mortality. Conclusions: Acute PD in critically ill children with renal impairment is a lifesaving procedure. Treatment of shock with resuscitative measures and respiratory failure with mechanical ventilation, along with PD, resulted in favorable renal outcome.

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Section: Discussionmentioning

confidence: 87%

Peritoneal dialysis in critically ill children in resource-limited setting: A prospective cohort study

et al. 2020

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“…Half of children [ 119 , 120 ] and an equal proportion of adults [ 6 ] with STEC-HUS will require renal replacement therapy during the acute phase. In adults, as opposed to children [ 232 ], peritoneal dialysis is rarely used in the ICU, and the literature concerning the benefits of continuous over intermittent hemodialysis is controversial. Therefore, the choice of renal replacement modality is mostly based on patients’ hemodynamic status, local expertise, and the availability of staff and resources [ 233 ].…”

Section: Managementmentioning

confidence: 99%

Shiga Toxin-Associated Hemolytic Uremic Syndrome: Specificities of Adult Patients and Implications for Critical Care Management

Travert

Rafat

Mariani

et al. 2021

Toxins

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Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS) is a form of thrombotic microangiopathy secondary to an infection by an enterohemorrhagic E. coli. Historically considered a pediatric disease, its presentation has been described as typical, with bloody diarrhea at the forefront. However, in adults, the clinical presentation is more diverse and makes the early diagnosis hazardous. In this review, we review the epidemiology, most important outbreaks, physiopathology, clinical presentation and prognosis of STEC-HUS, focusing on the differential features between pediatric and adult disease. We show that the clinical presentation of STEC-HUS in adults is far from typical and marked by the prevalence of neurological symptoms and a poorer prognosis. Of note, we highlight knowledge gaps and the need for studies dedicated to adult patients. The differences between pediatric and adult patients have implications for the treatment of this disease, which remains a public health threat and lack a specific treatment.

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“…However, the patterns of dialysis modality utilization appeared to change by the time CKRT became more accessible in different countries. For instance, a recent survey of 35 pediatric nephrology centers in 11 European countries reported that PD and CKRT were the most frequently used dialysis modalities for treating pediatric AKI, accounting for 39.4% and 38.2% of all treatments, followed by use of intermittent HD (22.4%) 26 . Over the period of 2010–2015, CKRT (with an annual rate ranging from 38 to 52%) and intermittent HD (annual rate ranging from 12 to 24%) were more commonly performed in pediatric patients in Ontario 21 .…”

Section: Discussionmentioning

confidence: 99%

Changing trends in dialysis modalities utilization and mortality in children, adolescents and young adults with acute kidney injury, 2010–2017

Tain

Kuo

Hsu

2021

Sci Rep

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The aim of the study was to assess trends in the relative use of dialysis modalities in the hospital-based pediatric cohort and to determine risk factors associated with in-hospital morality among pediatric patients receiving dialysis for acute kidney injury (AKI). Patients aged < 20 years who received dialysis between 2010 and 2017 were identified from electronic health records databases of a Taiwan’s healthcare delivery system. The annual uses of intermittent hemodialysis (HD), continuous and automated peritoneal dialysis (PD) and continuous kidney replacement therapy (CKRT) were assessed using Cochran-Armitage Tests for trend. Among patients who received their first dialysis as inpatients for AKI, a multivariate logistic regression model was employed to assess mortality risks associated with dialysis modalities, patient demographics, complexity of baseline chronic disease, and healthcare service use during their hospital stays. Kidney dialysis was performed 37.9 per patient per year over the study period. Intermittent hemodialysis (HD) (73.3%) was the most frequently used dialysis modality. In the inpatient setting, the relative annual use of CKRT increased over the study period, while HD use concomitantly declined (P < 0.0001). The overall in-hospital mortality rate after dialysis for AKI was 33.6%, which remained steady over time (P = 0.2411). Patients aged < 2 years [adjusted odds ratio: (aOR) 3.36; 95% confidence interval (CI) 1.34–8.93] and greater vasoactive regimen use (aOR: 17.1; 95% CI: 5.3–55.21) were significantly associated with dialysis-related mortality. Overall treatment modality used for dialysis in pediatric patients increased slowly in the study period, and HD and CRKT modality uses largely evolved in the inpatient setting. Younger ages and use of more vasoactive medication regimens were independently associated with increased early mortality in patients on AKI-dialysis.

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Acute dialysis in children: results of a European survey

Cited by 27 publications

References 30 publications

Peritoneal dialysis in critically ill children in resource-limited setting: A prospective cohort study

Peritoneal dialysis in critically ill children in resource-limited setting: A prospective cohort study

Shiga Toxin-Associated Hemolytic Uremic Syndrome: Specificities of Adult Patients and Implications for Critical Care Management

Changing trends in dialysis modalities utilization and mortality in children, adolescents and young adults with acute kidney injury, 2010–2017

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