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Updated: Mar 29, 2026
A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
Continuous renal replacement therapy in children with severe sepsis and multiorgan dysfunction - A pilot study on
Krishna Mohan Gulla1, Anil Sachdev1, Dhiren Gupta1
1Division of Pediatric Emergency and Critical Care, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India.
Insights
Early initiation of continuous renal replacement therapy (CRRT) in children with severe sepsis and multiorgan dysfunction syndrome (MODS) improved hemodynamics and oxygenation. Survival rates were significantly higher in patients receiving CRRT within 48 hours of ICU admission.
Area of Science:
- Pediatric critical care medicine
- Nephrology
- Intensive care medicine
Background:
- Limited data exists on continuous renal replacement therapy (CRRT) for severe sepsis and multiorgan dysfunction syndrome (MODS) in developing nations.
- This study details the experience of a single unit with pediatric CRRT in this patient population.
Purpose of the Study:
- To describe the utilization of CRRT in children with sepsis and MODS.
- To assess the impact of early CRRT initiation on patient outcomes.
Main Methods:
- A retrospective analysis of 27 children (<16 years) requiring CRRT for sepsis and MODS between September 2010 and February 2015.
- Data collected included demographics, CRRT timing, hemodynamic and oxygenation parameters, and outcomes.
- Comparison between survivors and non-survivors, and analysis based on CRRT initiation timing (within vs. after 48 hours of ICU admission).
Main Results:
- Twenty-seven children (16 male, median age 11 years) received CRRT; 21 had severe sepsis with MODS.
- Survivors showed statistically significant improvements in P/F ratio, reduced plateau pressure, and lower vasoactive-inotropic scores compared to non-survivors.
- Survival rate was 61.1% for early CRRT (within 48 hours) versus 33.3% for late CRRT (after 48 hours) (P=0.0001).
Conclusions:
- CRRT plays a role in improving oxygenation and hemodynamic status in pediatric sepsis with MODS.
- Early initiation of CRRT may offer a survival benefit in this critically ill population.
- Multicenter randomized controlled trials are needed to confirm mortality benefits.
Objective:
Scanty literature is available regarding continuous renal replacement therapy (CRRT) utility in severe sepsis with multiorgan dysfunction syndrome (MODS) from developing countries. Author unit's experience in pediatric CRRT is described and outcome of early initiation of CRRT with sepsis and MODS is assessed.
Materials And Methods:
Children aged <16 years with sepsis and MODS who required CRRT from September 2010 to February 2015 were analyzed on demographic factors, timing of initiation of CRRT, mode of CRRT, effect of CRRT onhemodynamics, oxygenation parameters, and outcome.
Results:
Twenty-seven children required CRRT (male - 16). The median age was 11 years (range 1.1-16). Twenty-one had severe sepsis with MODS. Eighteen patients were given CRRT within 48 h of admission to Intensive Care Unit (ICU). Statistically significant improvement in the P/F ratio, decrement in plateau pressure and vasoactive-inotropic score were noted in survivor group compared to nonsurvivor group (P = 0.022, 0.00, and 0.03, respectively). There was no statistically significant difference in duration of ICU stay, fluid overload, CRRT duration, PRISM score at 12 and 24 h, percentage of decrease in inotrope score, plateau pressure, and percentage of increase in P/F ratio in relation to timing of CRRT initiation. However, the survival rate was 61.1% (11/18) who received CRRT within 48 h of ICU admission compared to 33.3% (3/9) who received after 48 h (P = 0.0001).
Conclusion:
Our study emphasizes the CRRT role in improving the oxygenation status and hemodynamics. Survival benefit may be expected in those children who receive CRRT early in the course of sepsis. However, multicenter RCTs are required to prove mortality benefit.
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