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Acute renal replacement therapy in pediatrics

Rajit K Basu1, Derek S Wheeler, Stuart Goldstein

  • 1Division of Critical Care and Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.

International Journal of Nephrology
|July 1, 2011
PubMed

Insights

Acute kidney injury (AKI) in children requires renal replacement therapy (RRT), but treatment decisions are complex. More research is needed to establish best practices for pediatric RRT.

Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Renal Replacement Therapy

Background:

  • Acute kidney injury (AKI) significantly increases hospital-related illness and death in children.
  • Renal replacement therapy (RRT) is vital for managing AKI and fluid overload but involves complex treatment decisions.
  • Current RRT practices in pediatrics lack a standardized approach due to limited evidence.

Purpose of the Study:

  • To review existing data on RRT utilization in pediatric patients.
  • To discuss various RRT modalities, their specific applications, and associated controversies.
  • To highlight the need for evidence-based guidelines in pediatric RRT.

Main Methods:

  • Systematic review of current literature on pediatric RRT.
  • Analysis of RRT modalities, including hemodialysis, peritoneal dialysis, and continuous renal replacement therapy.
  • Discussion of clinical considerations, patient-specific factors, and treatment center protocols.

Main Results:

  • No randomized controlled trials specifically for pediatric RRT have been conducted.
  • Decisions regarding RRT initiation and modality selection are influenced by patient stability and local resources.
  • Significant variability exists in RRT practices among pediatric treatment centers.

Conclusions:

  • There is a lack of consensus on optimal RRT strategies for pediatric AKI and multiorgan disease.
  • Prospective studies are essential to develop evidence-based best practice guidelines for pediatric RRT.
  • Standardized protocols could improve outcomes for children requiring RRT.

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