Continuous renal replacement therapy in critically ill children: single-center experience

Abstract

Background/aim Continuous renal replacement therapy (CRRT) has significant benefits in the treatment of critically ill children.The objective of this study is to describe the treatment indications, methods, demographics, and outcome of the patients who received CRRT in our pediatric intensive care unit and neonatal care unit, and, according to these results, we also aimto make improvements in our unit-based interventions. Materials and methods In this single-centered study, we retrospectively evaluated medical charts of the patients admitted to our intensive care units and received CRRT between February 2010 and November 2015. Results Fifty of 60 patients were included in this study. Newborns made up 28% (n = 14) of the patients. The mean body weight was 18.4 kg (2.3-98 kg). CRRT indications were fluid overload (30%), acute kidney injury (40%), metabolic disease (24%), electrolyte impairment (4%), and drug intoxication (2%). The most common method of CRRT was continuous venovenous hemodiafiltration (CVVHDF) (72%). The mean duration of CRRT was 135 hours (1-864) and totally 143 filters, polyarylethersulfon (n = 23.46%) and polyacrylonitrile (n = 27.54%) were used. Overall survival was 42%. The survival rate of newborns was significantly higher (P = 0.046). Conclusion CRRT is a lifesaving method that can be applied to critically ill children with acute kidney injury and fluid overload at any age and weight by experienced teams.

Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK)

“… 23 Single center, Saskatchewan CRRT 2007–2020 82 79% at discharge Erkol Tuncer et al. 24 Single center, Turkey CRRT 2010–2015 50 42% at discharge Lee et al . 25 Single center, Korea CRRT 2003–2016 263 30% at discharge Tain et al .…”

Risk factors for mortality in critically ill pediatric patients receiving continuous renal replacement therapy

“…소 아 중환자실에 입실한 환자의 30%에서 급성 신손상이 발생하며 이는 사망률과 밀접한 관련이 있다 [2]. 급성 신손상은 그 자체가 소아 환자 의 발병률과 사망률의 원인이 될 수 있으며 소아 중환자실에서 급성 신 손상이 발병할 경우 사망률은 66%-90%로 상대적으로 높다 [3]. 지난 10여 년간 소아에서 급성 신손상 발생빈도는 급격하게 증가하였고, 이 로 인한 다장기부전과 같은 심각한 문제로 이어져 사망률을 증가시킨 다 [4].…”

“…3 ), 혈소판(cells/mm 3 ), C-반응성 단백 (mg/dL), 사구체여과율(mL/min), 혈액 요소 질소(mg/dL), 혈장 크레 아티닌(mg/dL), 포타슘(mEq/L), 나트륨(mEq/L), 뇌나트륨이뇨펩티 드(pg/mL), 프로트롬빈시간(second), 활성화부분트롬보플라스틴시간 (second), 젖산(mmol/L), 혈당(mg/dL)을 조사하였다.소아 중증도 분류인 Pollack 등[9]이 개발한 Pediatric Risk of Mortality (PRISM) Ⅲ score를 조사하였고(SupplementaryTable 1), 지속적 신대체 요법을 적용한 소아 중환자의 사망위험 요인에 대한 단변 량 분석 지속적 신대체 요법을 적용한 소아 중환자의 사망에 유의한 영향을 미 치는 요인으로는 기저질환이 백혈병인 경우, 사망 위험은 기타 질환에 비해 odds ratio (OR)가 3.244 (95% Confidence interval [CI], 1.219-8.629; p = 0.018)였다. PRISM Ⅲ score, 승압제 사용 개수, 인공호흡 기를 적용한 경우, 체외막산소공급장치를 적용한 경우로 나타났다.…”