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Overview of pediatric renal replacement therapy in acute renal failure
1Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA. stuartg@bcm.tmc.edu
Insights
Pediatric acute renal failure (ARF) causes have shifted towards systemic disease complications. Treatment now favors continuous renal replacement therapy (CRRT) over peritoneal dialysis for critically ill children.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- The spectrum of diseases causing pediatric renal replacement therapy (RRT) has evolved.
- Historically, intrinsic renal disease and burns were primary causes of pediatric acute renal failure (ARF); however, recent trends show systemic disease complications are now more prevalent.
- Advancements in neonatal care, congenital heart surgery, and transplantation have altered ARF etiologies.
Purpose of the Study:
- To review evolving causes of pediatric RRT.
- To emphasize emerging trends in RRT modality selection and treatment timing.
- To analyze the application and outcomes of different RRT modalities in critically ill children with ARF.
Main Methods:
- Literature review of pediatric acute renal failure (ARF) and renal replacement therapy (RRT).
- Analysis of changing etiologies for pediatric RRT.
- Examination of shifts in RRT modality preferences, including peritoneal dialysis and continuous renal replacement therapy (CRRT).
Main Results:
- Pediatric ARF is increasingly linked to systemic disease complications, not just intrinsic renal issues.
- Continuous renal replacement therapy (CRRT) is becoming the preferred modality for critically ill children, replacing peritoneal dialysis.
- There is a notable lack of multicenter prospective outcome studies for pediatric ARF.
Conclusions:
- The causes of pediatric acute renal failure (ARF) necessitating renal replacement therapy (RRT) have significantly changed.
- Continuous renal replacement therapy (CRRT) represents an advancement in treating critically ill children with ARF.
- Further research, particularly multicenter prospective studies, is crucial to assess outcomes in pediatric ARF patients receiving RRT.
Abstract:
The disease spectrum leading to pediatric renal replacement therapy (RRT) provision has broadened over the last decade. In the 1980s, intrinsic renal disease and burns constituted the most common pediatric acute renal failure etiologies. More recent data demonstrate that pediatric acute renal failure (ARF) most often results from complications of other systemic diseases, resulting from advancements in congenital heart surgery, neonatal care, and bone marrow and solid organ transplantation. In addition, RRT modality preferences to treat critically ill children have shifted from peritoneal dialysis to continuous renal replacement therapy (CRRT) as a result of improvements in CRRT technologies. Currently, multicenter prospective outcome studies for critically ill children with ARF are sorely lacking. The aims of this article are to review the pediatric specific causes necessitating renal replacement therapy provision, with an emphasis on emerging practice patterns with respect to modality and the timing of treatment, and to focus upon the application of the different renal replacement therapy modalities and assessment of the outcome of children with ARF who receive renal replacement therapy.