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Continuous hemodiafiltration in children.

N A Bishof1, T R Welch, C F Strife

  • 1Department of Pediatrics, University of Cincinnati School of Medicine, Ohio.

Pediatrics
|May 1, 1990
PubMed
Summary
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Continuous arteriovenous hemodiafiltration (CAVHDF) is a safe and effective renal replacement therapy for critically ill children with acute renal failure. This method helps manage metabolic and electrolyte issues, particularly in cases like tumor lysis syndrome.

Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Renal Replacement Therapy

Background:

  • Continuous arteriovenous hemofiltration (CAVH) removes solutes and water via convection, managing fluid overload and azotemia.
  • CAVH may be insufficient for severe acute renal failure in critically ill children, with alternatives like hemodialysis or peritoneal dialysis being undesirable.
  • Continuous arteriovenous hemodiafiltration (CAVHDF), a related technique, has shown promise in severely ill adults.

Observation:

  • CAVHDF was utilized in four critically ill children with acute renal failure and contraindications for other dialysis methods.
  • Indications included perinatal asphyxia with oliguria, Burkitt lymphoma with tumor lysis syndrome, and septic shock post-bone marrow transplant.
  • The therapy was administered for durations ranging from 11 hours to 7 days, with blood pumps used in most cases.

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Findings:

  • No patient experienced cardiovascular deterioration or increased pressor support requirements during CAVHDF.
  • Two survivors (patients 2 and 4) with Burkitt lymphoma and tumor lysis syndrome regained normal renal function.
  • CAVHDF effectively managed metabolic and electrolyte abnormalities, proving beneficial for tumor lysis syndrome.

Implications:

  • CAVHDF represents a safe and effective renal replacement therapy option for critically ill pediatric patients.
  • This technique is particularly advantageous for children with acute renal failure who cannot tolerate conventional dialysis.
  • CAVHDF shows significant potential in managing the complex metabolic derangements associated with conditions like tumor lysis syndrome in pediatric intensive care settings.