Continuous renal replacement therapy (CRRT) after stem cell transplantation. A report from the prospective pediatric...

Area of Science:

• Pediatric Nephrology
• Critical Care Medicine
• Hematology/Oncology

Background:

• Acute renal failure (ARF) is a common complication in pediatric stem cell transplant (SCT) recipients.
• Continuous renal replacement therapy (CRRT) is frequently initiated for fluid overload and electrolyte imbalances in these patients.

Purpose of the Study:

• To analyze demographic and survival data of pediatric SCT patients undergoing CRRT.
• To identify factors influencing survival in pediatric SCT recipients requiring CRRT.

Main Methods:

• Retrospective analysis of pediatric SCT patients enrolled in the Prospective Pediatric Continuous Renal Replacement Therapy (ppCRRT) Registry from January 1, 2001.
• Data collected included demographics, reasons for CRRT initiation, CRRT modalities, co-morbidities (e.g., multi-organ dysfunction syndrome, ventilatory support), fluid overload, and survival rates.

Main Results:

• Of 370 pediatric SCT patients in the registry, 51 (13.8%) received CRRT. Median age was 13.63 years.
• Fluid overload and electrolyte imbalance were primary indications for CRRT (49%).
• Overall survival was 45%. Patients receiving convective CRRT therapies (CVVH, CVVHDF) had significantly better survival (59%) compared to non-convective therapies (CVVHD) (27%, P < 0.05). Ventilatory support was associated with worse survival (35% vs 71%, P < 0.05).

Conclusions:

• Convective CRRT modalities are associated with improved survival in pediatric SCT recipients with ARF.
• High mean airway pressure at CRRT cessation in non-survivors suggests non-fluid related injury, indicating limitations of CRRT in preventing all-cause mortality.
• Aggressive fluid management via CRRT may not prevent mortality from non-fluid related organ injury in this population.