Prolonged intermittent renal replacement therapy in children.

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.