Two decades' experience of renal replacement therapy in paediatric patients with acute renal failure

Area of Science:

• Pediatric Nephrology
• Critical Care Medicine
• Renal Replacement Therapy

Background:

• Childhood acute renal failure (ARF) and renal replacement therapy (RRT) have seen significant advancements over the past two decades.
• Treatment of underlying diseases contributing to ARF has also improved.

Purpose of the Study:

• To compare outcomes and treatment trends in critically ill pediatric patients with ARF requiring RRT over two distinct decades (1985-1994 and 1995-2004).
• To identify changes in patient demographics, mortality rates, and RRT modalities.

Main Methods:

• Retrospective review of critically ill pediatric patients with ARF who underwent RRT.
• Comparison of data from two 10-year periods: 1985-1994 and 1995-2004.
• Analysis of mortality rates, causes of ARF, and RRT techniques (continuous haemofiltration vs. continuous haemodiafiltration).

Main Results:

• The number of patients requiring RRT decreased from 87 in the first decade to 28 in the second.
• Overall mortality decreased from 45% to 39%.
• Mortality in patients older than one year dropped significantly (51% to 20%), but increased in infants under one year (38% to 88%), although the absolute number of deaths in this group decreased.
• ARF secondary to heart surgery, oncologic disorders, and sepsis declined.
• Treatment shifted from continuous haemofiltration to continuous haemodiafiltration.

Conclusions:

• Improved diagnosis and treatment of underlying conditions have reduced the need for RRT in critically ill children.
• Overall mortality has decreased, potentially due to evolving treatment strategies and RRT technology.
• High mortality rates in infants with ARF remain a critical challenge requiring further investigation and intervention.