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Published on: February 8, 2022
Long-duration (>4 weeks) continuous renal replacement therapy in critical illness
1Columbia University College of Physicians and Surgeons, Children's Hospital of New York-Presbyterian, New York, NY 10032, USA. jsb106@columbia.edu
Insights
Long-duration continuous renal replacement therapy (CRRT) in critically ill children showed similar survival rates compared to shorter durations. This study clarifies outcomes for prolonged CRRT use in pediatric intensive care.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Renal Replacement Therapy
Background:
- Continuous renal replacement therapy (CRRT) is used in critically ill children.
- Concerns exist regarding outcomes with prolonged CRRT (>4 weeks).
- The practice of long-duration CRRT in pediatrics is not well-described.
Observation:
- A retrospective chart review identified 39 pediatric patients treated with CRRT.
- Most patients had multiorgan dysfunction syndrome and required vasopressors.
- Median age was 6 years, with a significant proportion being infants.
Findings:
- Overall survival was 38%.
- Patients receiving long-duration CRRT (group 1) and shorter-duration CRRT (group 2) had similar demographics and baseline illness severity.
- Survival rates were comparable between the long-duration and shorter-duration CRRT groups (p=1).
Implications:
- Long-duration CRRT in critically ill children does not appear to negatively impact survival rates.
- Findings support the use of CRRT for extended periods when clinically indicated in pediatric patients.
- Further research may explore specific indications and optimal management strategies for prolonged CRRT.
Introduction:
Decreased pediatric survival has been reported with long-duration (>4 weeks) continuous renal replacement therapy (CRRT), though the practice has not been well-described.
Methods:
Retrospective chart review in a children's hospital of all patients treated with CRRT over 2 years (2003-4), including those who underwent long (group 1) and shorter duration (group 2) therapy.
Results:
We identified 39 patients: median age was 6 years (range: 0.3-23; 7 were infants), median PRISM III score was 16 (range: 4-35), and the most frequent primary diagnosis was a stem cell transplant (in 12 out of 39). At continuous renal replacement therapy initiation, almost all patients (38 out of 39) had multiorgan dysfunction syndrome, most (35 out of 39) were being treated with at least one inotrope or vasopressor, and median fluid overload was 18% (range: 1-43%). Survival was poor (38%). Groups 1 (n = 7) and 2 (n = 32) had similar age (p = 0.44), PRISM III score (p = 0.61), and stem cell transplant diagnosis (p = 0.65). At CRRT initiation, the incidence of multiorgan dysfunction syndrome (p=0.18), inotrope or vasopressor treatment (p = 0.56), and fluid overload severity (p = 0.71) were similar. Those in group 1 had a longer mean CRRT as well as persistent cardiovascular dysfunction limiting the utility of intermittent dialysis. Survival was similar between groups (p = 1).
Conclusions:
Critically-ill patients treated with long and shorter duration CRRT had a similar survival rate.
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