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Overview of pediatric renal replacement therapy in acute kidney injury

Stuart L Goldstein1

  • 1Department of Pediatrics, Baylor College of Medicine, Renal Dialysis Unit and Pheresis Service, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA. stuartg@bcm.edu

Seminars in Dialysis
|May 12, 2009
PubMed

Insights

The causes of pediatric acute kidney injury (AKI) requiring renal replacement therapy (RRT) have shifted towards systemic disease complications. Treatment preferences now favor continuous renal replacement therapy (CRRT) for critically ill children.

Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Renal Replacement Therapy

Background:

  • The etiologies of pediatric acute kidney injury (AKI) necessitating renal replacement therapy (RRT) have evolved significantly over the past decade.
  • Historically, intrinsic renal diseases and burns were primary causes of pediatric AKI, but recent trends show AKI often arises from complications of systemic diseases.
  • Advancements in congenital heart surgery, neonatal care, and transplantation have contributed to the changing landscape of pediatric AKI.

Purpose of the Study:

  • To review the evolving spectrum of pediatric-specific conditions requiring RRT.
  • To emphasize emerging practice patterns in RRT modality selection and treatment timing for pediatric AKI.
  • To focus on the application of different RRT modalities and assess outcomes in children with AKI receiving RRT.

Main Methods:

  • Review of current literature and clinical practice patterns regarding pediatric AKI and RRT.
  • Emphasis on emerging causes and treatment modalities, including continuous renal replacement therapy (CRRT).
  • Focus on outcome assessment for pediatric patients with AKI undergoing RRT.

Main Results:

  • Pediatric AKI is increasingly linked to complications from systemic diseases, particularly in the context of advanced medical interventions.
  • There has been a notable shift in RRT modality preference from peritoneal dialysis to CRRT for critically ill children.
  • A lack of multicenter prospective outcome studies for critically ill children with AKI receiving RRT is currently observed.

Conclusions:

  • The disease spectrum leading to RRT in children has broadened, with systemic complications becoming more prevalent.
  • Improvements in CRRT technology have influenced the shift towards its use in treating critically ill children with AKI.
  • Further prospective outcome studies are crucial to guide optimal RRT strategies and improve care for pediatric AKI patients.

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