Metabolic disturbances following the use of inadequate solutions for hemofiltration in acute renal failure

Abstract

Continuous renal replacement therapy (CRRT) has become an important supportive therapy for critically ill children with acute renal failure. In Turkey, commercially available diafiltration and replacement fluids cannot be found on the market. Instead, peritoneal dialysis fluids for dialysis and normal saline as replacement fluid are used. The first objective of this study was to examine metabolic complications due to CRRT treatments. The second objective was to determine demographic characteristics and outcomes of patients who receive CRRT. We did a retrospective chart review of all pediatric patients treated with CRRT between February and December 2004. Thirteen patients received CRRT; seven survived (53.8%). All patients were treated with continuous venovenous hemodiafiltration. Median patient age was 71.8 +/- 78.8 (1.5-180) months. Hyperglycemia occurred in 76.9% (n=10), and metabolic acidosis occurred in 53.8% (n=7) of patients. Median age was younger (48.8 vs.106.2 months), median urea level (106.2 vs. 71 mg/dl) and percent fluid overload (FO) (17.2% vs. 7.6%, respectively) were higher, and CRRT initiation time was longer (8.6 vs 5.6 days) in nonsurvivors vs. survivors for all patients, although these were not statistically significant. CRRT was stopped in all survivors, and four nonsurvivors (67%) were on renal replacement therapy at the time of death. Hyperglycemia and metabolic acidosis were frequently seen in CRRT patients when commercially available diafiltration fluids were not available. Using peritoneal dialysis fluid as dialysate is not a preferable solution. Early initiation of CRRT offered survival benefits to critically ill pediatric patients. Mortality was associated with the primary disease diagnosis.

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

“…The most commonly reported causes of ARF are congenital cardiac diseases, bone marrow transplantation, nephrotoxins, and sepsis. 17 In our study, 5.5% of the patient groups had primary renal impairment. Moreover, again in conformity with the literature, impairment depending on congenital cardiac disease was the most common one among the CRRT indications, and metabolic diseases were considered as a second indication.…”

“…Moreover, again in conformity with the literature, impairment depending on congenital cardiac disease was the most common one among the CRRT indications, and metabolic diseases were considered as a second indication. 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.…”

Clinical Outcome Following the Use of Inadequate Solutions for Continuous Veno-Venous Hemodiofiltration

“…[4,19,20] while others suggested that correction of acidosis with lactatebuffered CVVHDF solutions. [4,11] Soysal et al [2] demonstrated that 1.36% PD solution induced metabolic acidosis when used as CVVHDF fluid. Our study confirms this previous study.…”

“…Furthermore, if dextrose-containing PD solutions is used as dialysate in CRRT, roughly 45-60% of the dextrose is absorbed, and the high-glucose concentration in peritoneal dialysate may aggravate hyperglycemia. [12] Soysal et al [2] used PD solution as dialysate for CRRT in pediatric patients and demonstrated that hyperglycemia was the most common complication in these patients. Hyperglycemia increases mortality in critically ill patients.…”

“…[1,2] Severe ARF requires renal replacement therapy. Continuous renal replacement therapy (CRRT) is currently used in critically ill patients with ARF.…”