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Renal Replacement Therapy in Pediatric Acute Kidney Injury

Sidharth Kumar Sethi1, Ronith Chakraborty2, Hirva Joshi3

  • 1Pediatric Nephrology & Pediatric Kidney Transplantation, Kidney and Urology Institute, Medanta, The Medicity Hospital, Gurgaon, India.

Indian Journal of Pediatrics
|January 12, 2020
PubMed

Insights

Acute kidney injury (AKI) affects many critically ill children, with high mortality despite advanced care. This review details renal replacement therapy (RRT) options for pediatric patients, including peritoneal dialysis, hemodialysis, CRRT, and SLED.

Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Renal Replacement Therapy

Background:

  • Acute kidney injury (AKI) is a frequent complication in critically ill children, impacting 30-40% of pediatric intensive care unit (ICU) admissions.
  • Mortality rates for pediatric ICU patients with AKI remain high (66.8%-90%) despite technological advancements.
  • Renal replacement therapy (RRT) is a vital treatment for AKI in this population.

Purpose of the Study:

  • To review and discuss the various modalities of RRT available for pediatric patients with AKI.
  • To highlight the importance of considering indications, access, and prescription for optimal RRT outcomes.
  • To provide a comprehensive overview of peritoneal dialysis (PD), hemodialysis (HD), continuous RRT (CRRT), and sustained low-efficiency dialysis (SLED) in pediatric critical care.

Main Methods:

  • Literature review of RRT modalities in pediatric critical care.
  • Synthesis of information on indications, access, and prescription for different RRT methods.
  • Comparative discussion of PD, HD, CRRT, and SLED for pediatric AKI.

Main Results:

  • AKI is prevalent in critically ill children, associated with significant mortality.
  • RRT is essential for managing pediatric AKI.
  • Various RRT methods (PD, HD, CRRT, SLED) exist, each with specific considerations.

Conclusions:

  • Optimal RRT in pediatric AKI requires careful selection of modality, access, and prescription.
  • Understanding the nuances of PD, HD, CRRT, and SLED is crucial for improving outcomes in critically ill children with AKI.
  • This review provides a foundational overview for clinicians managing pediatric AKI requiring RRT.

Keywords:
Acute kidney injuryDialysisPediatricRenal replacement therapy

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