Complications of continuous renal replacement therapy in critically ill children: a prospective observational evaluation study

Abstract

IntroductionContinuous renal replacement therapy (CRRT) frequently gives rise to complications in critically ill children. However, no studies have analyzed these complications prospectively. The purpose of this study was to analyze the complications of CRRT in children and to study the associated risk factors.MethodsA prospective, single-centre, observational study was performed in all critically ill children treated using CRRT in order to determine the incidence of complications related to the technique (problems of catheterization, hypotension at the time of connection to the CRRT, hemorrhage, electrolyte disturbances) and their relationship with patient characteristics, clinical severity, need for vasoactive drugs and mechanical ventilation, and the characteristics of the filtration techniques.ResultsOf 174 children treated with CRRT, 13 (7.4%) presented problems of venous catheterization; this complication was significantly more common in children under 12 months of age and in those weighing less than 10 kg. Hypotension on connection to CRRT was detected in 53 patients (30.4%). Hypotension was not associated with any patient or CRRT characteristics. Clinically significant hemorrhage occurred in 18 patients (10.3%); this complication was not related to any of the variables studied. The sodium, chloride, and phosphate levels fell during the first 72 hours of CRRT; the changes in electrolyte levels during the course of treatment were not found to be related to any of the variables analyzed, nor were they associated with mortality.ConclusionsCRRT-related complications are common in children and some are potentially serious. The most common are hypotension at the time of connection and electrolyte disturbances. Strict control and continuous monitoring of the technique are therefore necessary in children on CRRT.

Incidence of Adverse Events during Continuous Renal Replacement Therapy

“…Santiago et al reported that 30% of patients on CRRT developed hypotension in the hour following initiation of treatment, similar to the 43% observed in our study [17] . Electrolyte abnormalities have also been previously described.…”

“…Hypotension and electrolyte disturbances following initiation of CRRT have been reported as the most common AEs [5,12,17] . Various studies have described the individual AEs, safety and usefulness of CRRT in critically ill patients over the last decade [15,17,18] , especially in children [17,[19][20][21] .…”

“…Various studies have described the individual AEs, safety and usefulness of CRRT in critically ill patients over the last decade [15,17,18] , especially in children [17,[19][20][21] . However, very few studies systematically investigated the incidence of CRRT-related AEs in adult populations, including hemodynamic instability, electrolyte disturbances, coagulopathy and others [15][16][17]22] . It is also often difficult to distinguish between AEs related to CRRT and those related to comorbid conditions or the critical illness itself [23].…”

Continuous Veno-Venous Hemodialysis Using the Cardio-Renal Pediatric Dialysis Emergency Machine^TM: First Clinical Experiences

“…In a case series of 174 children requiring CRRT, hypotension on connection was detected in 53 patients (30.4%) [16]. Extracorporeal circuit priming volume ideally should not exceed 10% of a patient's circulating blood volume in order to avoid acute blood depletion from the circulation at the start of the extracorporeal treatment.…”

Complications During Continuous Renal Replacement Therapy in Critically Ill Neonates

“…In adults and children, some of the complications that can sometimes arise with eRRT include intradialytic hypotension (IDH), hemorrhage, electrolyte disturbances, hypothermia, and thrombocytopenia [7][8][9]. Although these complications have been clinically observed in CRRT in critically ill neonates, few reports have focused on complications during CRRT [10,11].…”