Renal replacement therapy in acute renal failure in children

Acute renal failure in children differs from adult patients in incidence, pathogenesis and size of the patient, but outcome is significantly better. Specific problems are access and haemodynamic stability. Where increasing reporting on the use of CRRT in children seems to convince that CRRT is the treatment of choice, we have to stress that there is no evidence for this statement. Part of this misunderstanding is that both peritoneal and haemodialysis techniques from chronic renal replacement therapy (RRT) are simply extrapolated to intensive care setting. In this paper we want to elaborate on several adaptations in the dialysis-prescription of both peritoneal dialysis and haemodialysis in the ARF setting, which may improve efficacy and outcome. Introduction of new peritoneal dialysis catheter techniques, the cyclers, bicarbonate solutions, combined glucose/amino acid solutions, and low sodium-solutions have overcome many of the inconveniences of the old CAPD-technique. Slow SLED haemodialysis, with an ambulant Genius haemodialyser, with the use of ultra pure water adds to the benefits of conventional haemodialysis (monitoring, safetyness) to better haemodynamic stability of CRRT techniques.