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Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...
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Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
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Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Peritoneal dialysis (PD) is a medical process that removes waste products and excess fluid from the body using the peritoneal membrane as a natural filter.Peritoneal Dialysis MethodsSeveral methods can be used for peritoneal dialysis, including Acute Intermittent Peritoneal Dialysis, Continuous Ambulatory Peritoneal Dialysis, and Automated Peritoneal Dialysis, also known as Continuous Cyclic Peritoneal Dialysis.Acute Intermittent Peritoneal Dialysis (AIPD) is used for patients with uremic...
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Articles linked to this work by shared authors, journal, and citation graph.

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A Hierarchical Endpoint Analysis of the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) Cohort.

Clinical journal of the American Society of Nephrology : CJASN·2026
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Prevalence of Acute Kidney Injury and Its Association With Outcomes in Children With Severe Traumatic Brain Injury: A Secondary Exploratory Analysis of the 2014-2017 "Approaches and Decisions for Acute Pediatric Traumatic Brain Injury" Study.

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·2026
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The Design of Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease Extracorporeal Membrane Oxygenation Study.

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Hypophosphatemia in Pediatric Patients on Continuous Kidney Replacement Therapy-A WE-ROCK Study.

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Improving CKRT Outcomes in Neonates and Infants through Interdisciplinary Collaboration (ICONIIC): Education Practices and Care Delivery Models.

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Current practices in pediatric continuous kidney replacement therapy: a systematic review-guided multinational

Dana Y Fuhrman1,2,3, Katja M Gist4, Ayse Akcan-Arikan5,6

  • 1Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA. dana.fuhrman@chp.edu.

Pediatric Nephrology (Berlin, Germany)
|January 10, 2023
PubMed
Summary

Current pediatric continuous kidney replacement therapy (CKRT) practices largely mirror adult care, with consensus on initiation, dosing, and anticoagulation but variability in monitoring and quality assessment. Further research is needed to optimize pediatric CKRT outcomes.

Keywords:
Acute kidney injuryChildrenContinuous kidney replacement therapyPediatric intensive care unit

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Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Renal Replacement Therapy

Background:

  • Continuous kidney replacement therapy (CKRT) is vital for critically ill children, yet current prescribing and delivery practices lack clarity.
  • This study aimed to define contemporary pediatric CKRT practices.

Approach:

  • A systematic literature review (2012-2022) identified CKRT data on initiation, dosing, anticoagulation, fluid removal, and quality monitoring.
  • A multinational, two-round modified Delphi survey of 147/126 pediatric CKRT prescribers refined practice insights.

Key Points:

  • Consensus was reached on 26 statements regarding CKRT initiation, dosing, anticoagulation methods, and fluid removal.
  • Significant variability exists in anticoagulation monitoring and treatment quality assessment methods among practitioners.
  • Pediatric CKRT practices appear heavily influenced by adult patient care protocols.

Conclusions:

  • Current pediatric CKRT practices largely reflect a decade of literature, predominantly based on adult data.
  • This study establishes a foundation for investigating best practices to enhance outcomes for pediatric CKRT patients.