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Continuous renal replacement therapy and plasma exchange in newborns and infants
Rafael Ponikvar1, Aljosa Kandus, Alenka Urbancic
1Department of Nephrology, University Medical Center, Ljubljana, Slovenija. rafael.ponikvar@uni-lj.si
Insights
Continuous renal replacement therapy (CRRT) and plasma exchange (PE) offer a feasible and safe treatment for critically ill newborns and infants with acute renal failure. These methods provided a chance for survival in this vulnerable patient population.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Neonatology
Background:
- Critically ill newborns and infants often develop acute renal failure (ARF) and multiple organ failure (MOF).
- Peritoneal dialysis is frequently unsuitable for these small patients.
- Continuous renal replacement therapy (CRRT) and plasma exchange (PE) are advanced extracorporeal techniques that may offer therapeutic options.
Purpose of the Study:
- To present the experience and evaluate the feasibility, efficiency, and safety of CRRT and PE in treating critically ill small children with ARF and MOF.
- To assess patient outcomes, including renal function recovery and survival rates.
Main Methods:
- Retrospective analysis of 21 critically ill children (14 newborns, 7 infants) treated with CRRT and/or PE from March 1986 to April 2000.
- Utilized CRRT and PE monitors with double lumen hemodialysis catheters for vascular access.
- Employed low-dose heparin and prostacyclin for anticoagulation, with lactate or bicarbonate buffered solutions used predilutionally.
Main Results:
- 10 of 21 patients (47.6%) recovered renal function, and 9 of 21 patients (42.9%) survived.
- Survivors had significantly fewer failing organs (3.6 ± 0.5) compared to non-survivors (4.8 ± 0.9) (p = 0.0008).
- Reported side events included circuit clotting, catheter malfunction, hypotension, and pulmonary edema.
Conclusions:
- Pump-driven CRRT and PE are feasible, efficient, and safe procedures for newborns and infants with ARF and MOF.
- These extracorporeal therapies may be crucial for the survival of critically ill pediatric patients when other methods are inappropriate.
Abstract:
The objective of our study was to present our experience in the treatment of small children with continuous renal replacement therapy (CRRT) and plasma exchange (PE). From March 1986 to April 2000, 21 critically ill children (14 newborns and 7 infants) with acute renal failure (ARF) and multiple organ failure were treated with CRRT and PE. In the newborn group, there were 8 males and 6 females, age 15.7 +/- 11.7 days, with body weights of 3,348 +/- 585 g. In the infant group, there were 4 males and 3 females, age 118 +/- 67 days, with body weights 5,186 +/- 734 g. The indications for the beginning of CRRT and/or PE were ARF with anuria and hyperhydration (17 patients), azotemia and anuria (1 patient), hemolytic uremic syndrome (1 patient), and hyperammonemia (2 patients). In all patients, peritoneal dialysis was considered inappropriate. PE and CRRT monitors were used, double lumen 5 Fr and 7 Fr hemodialysis catheters were the vascular access, low dose heparin and prostacyclin were anticoagulants, and lactate or bicarbonate buffered replacement solutions were used predilutionally. Side events were clotting within the extracorporeal circuit, catheter malfunction, serious hypotension (6 patients), and pulmonary edema (1 patient). Ten of 21 patients (47.6%) recovered renal function and 9 of 21 patients (42.9%) survived. Survivors had fewer failing organs (3.6 +/- 0.5) than nonsurvivors (4.8 +/- 0.9) (p = 0.0008). Pump driven CRRT and PE were feasible, efficient, and safe procedures in newborns and infants. Without CRRT, it is uncertain whether any of our patients would have the chance to survive.