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Experience with Continuous Renal Replacement Therapy
Priyanka Khandelwal1, Sonia Sharma, Swati Bhardwaj
1Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
Insights
Continuous renal replacement therapy (CRRT) in critically ill children in developing nations is scarce. This study shows CRRT effectively managed acute kidney injury (AKI) and fluid overload in 17 children, with 47.1% survival and recovered renal function.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Limited data exists on continuous renal replacement therapy (CRRT) for critically ill children in developing countries.
- Acute kidney injury (AKI) and fluid overload are significant challenges in this population.
Purpose of the Study:
- To describe the experience and outcomes of CRRT in critically ill children with AKI and fluid overload in a developing country setting.
- To evaluate the safety and efficacy of CRRT in this underrepresented patient group.
Main Methods:
- Retrospective analysis of 17 critically ill children managed with 20 sessions of CRRT.
- Patients presented with hypotension, AKI, fluid overload, or electrolyte imbalance.
- Data collected included patient demographics, CRRT parameters, complications, and survival rates.
Main Results:
- Median age was 6 years, median weight 20 kg.
- CRRT provided effective solute clearance (median 2171.4 ml/1.73 m²/h) with a median filter-life of 69.7 hours.
- Common complications included hypokalemia (n=16) and hypophosphatemia (n=11). Survival rate was 47.1% (8/17 patients).
Conclusions:
- CRRT is a viable and effective modality for managing critically ill children with AKI and fluid overload in developing countries.
- Despite complications, survivors showed improved renal function, highlighting CRRT's role in improving outcomes.
- Further research is needed to optimize CRRT delivery in resource-limited settings.
Abstract:
Information on provision of continuous renal replacement therapy (CRRT) in critically ill children from developing countries is limited. The authors describe their experience in 17 children with hypotension and acute kidney injury (AKI) with fluid overload or electrolyte imbalance managed by 20 sessions of CRRT. The median (range) age and weight were 6 y (0.75-18) and 20 kg (6.2-42), respectively. All patients were receiving inotropic agents; nine had fluid overload (19 %, range 11-34.1 %) and ten had severe AKI. Median clearance and filter-life were 2171.4 ml/1.73 m(2)/h (1730.6-4405.8) and 69.7 h (2.8-98.3), respectively. Complications were catheter flow related (n = 1), filter clotting (n = 3), hemorrhage (n = 3), hypokalemia (n = 16) and hypophosphatemia (n = 11). Eight patients (47.1 %) survived; the median PRISM III score of survivors was significantly lower than non survivors (10.5 vs.17.0; P 0.02). Renal function recovered in the survivors emphasizing the role of this modality in managing critically ill patients.
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