PCRRT Expert Committee ICONIC Position Paper on Prescribing Kidney Replacement Therapy in Critically Sick Children...

Area of Science:

• Pediatric Nephrology
• Hepatology
• Critical Care Medicine

Background:

• Acute liver failure (ALF) and acute on chronic liver failure (ACLF) present complex management challenges in children.
• Kidney dysfunction, including hepatorenal syndrome (HRS) and acute kidney injury (AKI), is a significant complication in pediatric liver failure, often indicating a poor prognosis.

Purpose of the Study:

• To address the challenges in managing kidney manifestations of pediatric liver failure.
• To explore the incidence and treatment strategies for acute kidney injury (AKI) in children with ALF.
• To evaluate expert clinical opinions on kidney replacement therapy (KRT) for pediatric liver failure patients.

Main Methods:

• Review of current literature and clinical practices regarding kidney dysfunction in pediatric ALF.
• Analysis of factors contributing to underestimation of AKI incidence in this population.
• Evaluation of expert consensus on KRT modalities, timing, and technical aspects for pediatric patients.

Main Results:

• The precise incidence of AKI in pediatric ALF is not well-established, potentially underestimated due to factors like reduced creatinine production and impaired kidney perfusion.
• Current treatments include conservative management, fluids, and KRT.
• Expert opinions provide guidance on optimal KRT strategies in the absence of robust evidence-based recommendations.

Conclusions:

• Kidney dysfunction is a critical concern in pediatric ALF and ACLF.
• Accurate assessment of kidney function in these patients is difficult, leading to potential underestimation of AKI.
• Expert consensus is crucial for guiding KRT in pediatric liver failure management.