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Controversies in paediatric continuous renal replacement therapy.
Graeme Maclaren1, Warwick Butt
1Departments of Paediatrics and Cardiac Surgery, National University Health System, Singapore, Singapore. gmaclaren@iinet.net.au
Intensive Care Medicine
|February 3, 2009
Summary
Continuous renal replacement therapy (CRRT) in children is vital for critical illnesses. Early initiation and specific methods like continuous hemodialysis with citrate anticoagulation may improve outcomes, though optimal application remains debated.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Renal Replacement Therapies
Background:
- Continuous renal replacement therapy (CRRT) supports critically ill children with diverse conditions like acute renal failure and multiorgan failure.
- Despite its value, the optimal application of CRRT in pediatric patients remains undetermined.
Purpose of the Study:
- To review the basic techniques of CRRT in children.
- To highlight differences in CRRT prescription between pediatric and adult patients.
- To discuss current controversies and evidence regarding CRRT application in pediatric critical care.
Main Methods:
- Literature review focusing on CRRT in pediatric critical care.
- Analysis of existing evidence and clinical controversies.
- Discussion of findings from a prospective, multicentre pediatric CRRT registry.
Main Results:
- CRRT indications, mode, dose, and anticoagulation strategies are subjects of ongoing debate.
- Large-scale randomized trials comparable to adult medicine are lacking in the pediatric population.
- A prospective, multicentre pediatric CRRT registry has been established.
Conclusions:
- Early CRRT initiation before significant fluid overload may improve outcomes.
- Continuous hemofiltration for conditions like post-stem cell transplant respiratory failure is considered.
- Continuous hemodialysis and citrate anticoagulation show potential for prolonging circuit life and improving outcomes.
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