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Basics of continuous renal replacement therapy in pediatrics
Jacob C John1, Sara Taha1, Timothy E Bunchman1
1Department of Pediatric Nephrology, Children's Hospital of Richmond at the Virginia Commonwealth University, Richmond, VA, USA.
Insights
Continuous renal replacement therapy (CRRT) has advanced pediatric intensive care, offering a crucial treatment for critically ill children with kidney issues. This review explores the evolution and benefits of CRRT in managing pediatric renal replacement therapy.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Significant advancements in pediatric renal replacement therapy (RRT) have occurred over the last three decades.
- Continuous renal replacement therapy (CRRT) has become a standard treatment in pediatric intensive care units (PICUs).
- CRRT adoption is driven by clinical experience and improvements in technology, vascular access, and anticoagulation.
Purpose of the Study:
- To review the historical progression of RRT in children.
- To highlight the advancements in continuous renal replacement therapy (CRRT) for critically ill pediatric patients.
- To discuss the current status and benefits of CRRT in pediatric intensive care.
Main Methods:
- Review of historical data and clinical literature on pediatric renal replacement therapy.
- Analysis of the evolution of hemodialysis, peritoneal dialysis, and continuous venovenous hemofiltration (CRRT).
- Examination of factors contributing to the widespread use of CRRT in PICUs.
Main Results:
- CRRT is now a mainstay in PICUs for hemodynamically compromised children requiring dialysis.
- CRRT offers advantages in slow, continuous solute and fluid clearance.
- While renal insufficiency affects up to 25% of PICU patients, the actual need for RRT is around 4%.
Conclusions:
- Continuous renal replacement therapy (CRRT) represents a major advancement in the care of critically ill children with kidney failure.
- The efficacy and safety of CRRT have been enhanced by technological and clinical progress.
- Understanding the history and progress of CRRT is vital for optimizing pediatric intensive care.
Abstract:
In the last three decades, significant advances have been made in the care of children requiring renal replacement therapy (RRT). The move from the use of only hemodialysis and peritoneal dialysis to continuous venovenous hemofiltration with or without dialysis (continuous renal replacement therapy, CRRT) has become a mainstay in many intensive care units. The move to CRRT is the result of greater clinical experience as well as advances in equipment, solutions, vascular access, and anticoagulation. CRRT is the mainstay of dialysis in pediatric intensive care unit (PICU) for critically ill children who often have hemodynamic compromise. The advantages of this modality include the ability to promote both solute and fluid clearance in a slow continuous manner. Though data exist suggesting that approximately 25% of children in any PICU may have some degree of renal insufficiency, the true need for RRT is approximately 4% of PICU admissions. This article will review the history as well as the progress being made in the provision of this care in children.
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