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Renal replacement therapies in pediatric multiorgan dysfunction syndrome
1Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. lhl3@po.cwru.edu
Insights
Continuous hemodiafiltration (CHDF) is more effective than peritoneal dialysis (PD) for managing fluid overload in children with multiorgan dysfunction syndrome (MODS). This finding is crucial for improving renal support in critically ill pediatric patients.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Acute renal failure is a common complication in children with multiorgan dysfunction syndrome (MODS).
- Fluid overload is a significant challenge in managing pediatric MODS, impacting patient outcomes.
- Peritoneal dialysis (PD) and continuous hemodiafiltration (CHDF) are utilized for renal support in these patients.
Purpose of the Study:
- To compare the effectiveness of PD and CHDF in managing fluid balance in pediatric patients with MODS.
- To analyze fluid control achieved by each modality in children experiencing fluid overload.
Main Methods:
- Retrospective review of medical records for pediatric patients with MODS treated with PD or CHDF.
- Analysis of fluid balance in patients with documented fluid overload treated for over 24 hours.
- Definition of successful fluid control as greater fluid output than input.
Main Results:
- CHDF was used in 37 patients (median age 47 months) for a mean of 110 hours.
- PD was initiated in 25 patients (median age 4 months) for a mean of 145 hours.
- Successful fluid control was achieved in 65% of CHDF patients versus 36% of PD patients (P < 0.01).
Conclusions:
- CHDF demonstrates superior efficacy compared to PD in treating and preventing fluid overload in pediatric MODS.
- These findings suggest CHDF as a preferred modality for fluid management in critically ill children with renal failure.
- Optimizing fluid balance is critical for improving outcomes in pediatric patients with MODS requiring renal support.
Abstract:
Both peritoneal dialysis (PD) and continuous hemodiafiltration (CHDF) techniques are used in children who develop acute renal failure as part of multiorgan dysfunction syndrome (MODS). An important goal of renal support in MODS is treatment and prevention of fluid overload. This report describes an experience with PD and CHDF in children with MODS and presents an analysis of fluid balance for each modality. Medical records of patients with MODs treated with PD/CHDF were reviewed. Fluid balance was studied only in patients with documented fluid overload treated with PD/CHDF for more than 24 h. Successful fluid control was defined as more fluid output than input over the course of PD/CHDF. CHDF was used in 37 patients, median age 47 months (range 0.2-284 months), for a mean of 110 h (range 4-733 h). PD was initiated in 25 patients, median age 4 months (range 0.1-156 months), for a mean of 145 h (range 7-992 h). Successful fluid control was achieved in 17 of 26 (65%) CHDF patients and in 5 of 14 (36%) PD patients (P < 0.01, chi-squared). In conclusion, CHDF is more effective than PD in treating and preventing fluid overload in children with MODS.