Kidney support therapy in the pediatric patient: Unique considerations for a unique population

Area of Science:

• Pediatric Nephrology
• Critical Care Medicine
• Renal Replacement Therapy

Background:

• Kidney support therapy (KST) use in pediatric acute kidney injury (AKI) has significantly expanded over recent decades.
• This growth extends to neonates, presenting new avenues for research, education, and clinical practice enhancement.
• Pediatric KST shares many controversies with adult critical care nephrology, alongside unique challenges and advancements.

Purpose of the Study:

• To review the paradigms of pediatric kidney support therapy (KST) for managing acute kidney injury (AKI) in children.
• To explore the principles, novel technologies, and ethical considerations in pediatric KST.
• To discuss key management aspects including anticoagulation, dosing, modality, and priming procedures.

Main Methods:

• Literature review focusing on pediatric kidney support therapy (KST) for acute kidney injury (AKI).
• Analysis of governing principles, mechanics of KST, and newer support machines.
• Examination of ethical considerations, anticoagulation strategies, dosing, modality selection, and priming procedures.

Main Results:

• The field of pediatric KST is rapidly evolving, with significant advancements in technology and understanding.
• Fluid overload has emerged as a critical factor in KST initiation and management, driving quality improvement initiatives.
• Pediatric KST is at the forefront of exploring new frontiers in critical care nephrology.

Conclusions:

• Pediatric kidney support therapy (KST) is a dynamic and expanding field crucial for managing acute kidney injury (AKI) in young patients.
• The review highlights the importance of addressing controversies, embracing technological innovation, and considering ethical implications in pediatric KST.
• Further research and clinical practice improvements in pediatric KST are essential for optimizing outcomes and advancing critical care nephrology.