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Renal Replacement Therapy Modalities in Critically Ill Children.

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Continuous renal replacement therapy is common in critically ill children, but associated with higher mortality. Hemodialysis and peritoneal dialysis show lower mortality rates in pediatric intensive care units.

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Area of Science:

  • Pediatric Critical Care Medicine
  • Nephrology
  • Intensive Care Unit Management

Background:

  • Renal replacement therapy (RRT) is crucial for critically ill children with kidney injury.
  • Understanding the utilization and outcomes of different RRT modalities is essential for optimizing patient care.

Purpose of the Study:

  • To determine the relative frequency of continuous renal replacement therapy (CRRT), intermittent hemodialysis (IHD), and peritoneal dialysis (PD) in critically ill children.
  • To analyze the characteristics and outcomes of these pediatric patients.

Main Methods:

  • Retrospective analysis of a database from pediatric intensive care units (PICUs) participating in the Virtual PICU (VPS) registry.
  • Inclusion of critically ill children who received RRT between January 1, 2009, and December 31, 2015.

Main Results:

  • CRRT was the most frequent modality (46.5%), followed by IHD (35.5%) and PD (18%).
  • Overall mortality was 22.3%. Higher mortality was associated with cancer, mechanical ventilation, extracorporeal membrane oxygenation, and CRRT.
  • Lower mortality was observed with IHD and PD.

Conclusions:

  • CRRT is an increasingly prevalent RRT modality in critically ill children.
  • The higher mortality associated with CRRT requires cautious interpretation, considering patient complexity and disease severity.