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Published on: February 2, 2021
Prolonged intermittent renal replacement therapy in children
Rajiv Sinha1, Sidharth Kumar Sethi2, Timothy Bunchman3
1Institute of Child Health and AMRI Hospital, 37, G Bondel Road, Kolkata, West Bengal, 700019, India. rajivsinha_in@yahoo.com.
Insights
Prolonged intermittent renal replacement therapy (PIRRT) offers a cost-effective alternative to continuous treatments for pediatric acute kidney injury (AKI). This review explores PIRRT
Area of Science:
- Pediatric Nephrology
- Intensive Care Medicine
- Renal Replacement Therapy
Background:
- Pediatric acute kidney injury (AKI) management, especially in intensive care units (ICUs), presents unique challenges due to patient variability and hemodynamic instability.
- Continuous veno-venous hemofiltration/dialysis (CVVH/D) is standard in developed nations but often unavailable in resource-limited settings.
- Peritoneal dialysis (PD) is common in resource-poor areas but has limitations; intermittent hemodialysis (IHD) is explored as an alternative.
Purpose of the Study:
- To review the practical aspects of implementing prolonged intermittent renal replacement therapy (PIRRT) in pediatric patients.
- To summarize the current evidence and status of PIRRT for acute kidney injury in children.
- To highlight PIRRT as a potentially cost-effective RRT modality for pediatric ICUs.
Main Methods:
- Review of existing literature on slow, sustained intermittent hemodialysis (IHD) in pediatric populations.
- Synthesis of data on the efficacy and safety of various PIRRT modes.
- Discussion of practical considerations for PIRRT delivery in pediatric intensive care units (PICUs).
Main Results:
- Prolonged intermittent renal replacement therapy (PIRRT) is an umbrella term for slow, sustained IHD, offering an alternative to CVVH/D and PD.
- PIRRT has shown promising results in pediatric AKI, mirroring adult studies where it is as effective as CVVH/D.
- PIRRT presents a more cost-effective RRT option compared to CVVH/D, crucial for resource-limited facilities.
Conclusions:
- PIRRT is a viable and cost-effective renal replacement therapy for pediatric acute kidney injury, particularly in resource-constrained environments.
- Further pediatric data is needed, but current evidence suggests PIRRT is a promising modality for hemodynamically unstable children.
- This review provides practical insights into the application of PIRRT in the pediatric intensive care setting.
Abstract:
Wide ranges of age and weight in pediatric patients makes renal replacement therapy (RRT) in acute kidney injury (AKI) challenging, particularly in the pediatric intensive care unit (PICU), wherein children are often hemodynamically unstable. Standard hemodialysis (HD) is difficult in this group of children and continuous veno-venous hemofiltration/dialysis (CVVH/D) has been the accepted modality in the developed world. Unfortunately, due to cost constraints, CVVH/D is often not available and peritoneal dialysis (PD) remains the common mode of RRT in resource-poor facilities. Acute PD has its drawbacks, and intermittent HD (IHD) done slowly over a prolonged period has been explored as an alternative. Various modes of slow sustained IHD have been described in the literature with the recently introduced term prolonged intermittent RRT (PIRRT) serving as an umbrella terminology for all of these modes. PIRRT has been widely accepted in adults with studies showing it to be as effective as CVVH/D but with an added advantage of being more cost-effective. Pediatric data, though scanty, has been promising. In this current review, we elaborate on the practical aspects of undertaking PIRRT in children as well as summarize its current status.
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