Clinical course of children requiring prolonged continuous renal replacement therapy

Abstract

A prospective observational study was performed to analyze the clinical course of critically ill children who require continuous renal replacement therapy (CRRT). Variables associated with prolonged CRRT were analyzed. Of the 174 children treated with CRRT, 32 (18.3%) required CRRT for >14 days and 20 (11.5%) for >21 days. Prolonged CRRT was more common in patients with heart disease and those requiring mechanical ventilation, hemodiafiltration, and higher doses of heparin. The same factors were found when patients with CRRT for >14 days and 21 days were studied. Overall mortality rate was 35.6%; it was slightly higher in patients on prolonged CRRT (43.7% with CRRT > 14 days and 45% with CRRT >21 days), though the differences were not statistically significant. We conclude that there were no differences in the pre-CRRT clinical characteristics, severity of illness, and renal function in critically ill children requiring prolonged CRRT. Prolonged CRRT was more frequently required by patients with heart disease and those on mechanical ventilation. Patients with prolonged CRRT required more frequent hemodiafiltration and higher doses of heparin. Mortality was slightly higher in children with longer CRRT, though this difference did not reach statistical significance.

Pediatric continuous renal replacement therapy: have practice changes changed outcomes? A large single-center ten-year retrospective evaluation

“…Additionally, 53% of our patients were less than 20 kg and more than a quarter were less than 10 kg. This may be due to improving recognition of AKI in younger patients, and increasing comfort with providing CRRT for neonatal patients The shift towards smaller, younger patients also falls in line with more recently published single-center cohort studies, as shown in Table 7 [ 21 – 24 ].…”

Success of continuous veno-venous hemodiafiltration treatment in children monitored in the intensive care units

“…17 Impairment being the most common cause depending on congenital cardiac disease was associated with renal ischemia developed after cardiogenic shock in the literature. 6 Outcome rate in the literature was reported as between 34 and 52% in patients receiving CRRT. Likewise, 15 cases involved in our study of the 36 lived, and our outcome rate was determined as 42%.…”

“…Since continuous renal replacement therapy (CCRT) modalities provide sustainable blood clarification and they are adequate to systematic fluid removal in children who are in a critical condition in the ICU, CRRT modalities have been among the first and the most common modalities compared to peritoneal dialysis (PD) or intermittent hemodialysis (IHD). [5][6][7][8][9] It has been observed that ARF occurs particularly aftermath of the cardiac operations and CRRT is initiated at the rate of 1-17% in children of this group. 10 Despite the fact that lesser body surface area and body weights of the pediatric patients lead various kinds of problems in performing CRRT, outcome studies appearing in the pediatric nephrology literature confirm that clinicians' CRRT-based treatment choices rather than IHD and PD.…”

The gap between calculated and actual calcium substitution during citrate anticoagulation in an immobilised patient on renal replacement therapy reflects the extent of bone loss – a case report

“…A total CVVHD duration of 254 days is exceptional compared to reported prolonged CRRT-durations of >20 days [ 2 , 17 ]. As such, the extent to which citrate anticoagulation could promote bone demineralisation remains an important unanswered question.…”