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Outcome in children receiving continuous venovenous hemofiltration.
S L Goldstein1, H Currier, Graf Cd
1Department of Pediatrics, Renal Section, Baylor College of Medicine, Houston, Texas, USA.
Pediatrics
|June 5, 2001
Summary
Continuous venovenous hemofiltration (CVVH) with or without dialysis (D) is crucial for critically ill children with acute renal failure. Early initiation of CVVH/D may improve outcomes, especially when fluid overload is less severe.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Renal Replacement Therapy
Background:
- Continuous venovenous hemofiltration (CVVH) with or without dialysis (D) is a key supportive therapy for critically ill children with acute renal failure.
- Previous studies often combined CVVH/D with other renal replacement modalities or did not account for illness severity.
Purpose of the Study:
- To evaluate the outcomes of pediatric patients undergoing CVVH/D.
- To control for severity of illness using Pediatric Risk of Mortality (PRISM) scores.
Main Methods:
- A retrospective analysis of 21 pediatric patients (22 CVVH/D courses) was conducted.
- Patients' outcomes were assessed, controlling for illness severity with PRISM scores.
Main Results:
- The survival rate was 42.8% (9 out of 21 patients).
- Survivors had significantly lower fluid overload at CVVH/D initiation (16.4%) compared to nonsurvivors (34.0%), even after controlling for PRISM scores.
- CVVH/D costs represented only 1% of total pediatric intensive care unit (PICU) costs per patient.
Conclusions:
- Early initiation of CVVH/D in critically ill children with acute renal failure may improve outcomes.
- Lesser degrees of fluid overload at initiation correlate with better survival.
- The relatively low cost of CVVH/D supports its consideration as an early intervention.