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Published on: March 27, 2018
Extracorporeal pediatric renal replacement therapy: diversifying application beyond kidney failure
Rahul Chanchlani1, David Askenazi2, Benan Bayrakci3
1Department of Pediatrics, Division of Pediatric Nephrology, McMaster University, McMaster Children's Hospital, Hamilton, ON, Canada.
Insights
Extracorporeal renal replacement therapy (RRT) offers critical benefits beyond kidney support in critically ill children. This review highlights RRT
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Extracorporeal Therapies
Background:
- Renal replacement therapy (RRT), including continuous renal replacement therapy (CRRT) and hemodialysis (HD), is traditionally used for volume overload and acute kidney injury (AKI).
- There is a growing recognition of RRT's expanded applications in managing complex pediatric critical illnesses.
- Non-kidney indications for RRT are increasingly important for improving outcomes in critically ill children.
Purpose of the Study:
- To comprehensively review the non-kidney applications of RRT platforms in critically ill children.
- To explore the utility of RRT in diverse clinical scenarios beyond AKI.
- To consolidate evidence on RRT's role in sepsis, metabolic disorders, liver failure, and toxic ingestions.
Main Methods:
- Systematic literature review of extracorporeal renal replacement therapy applications.
- Analysis of RRT's role in sepsis, inborn errors of metabolism, liver failure, drug overdose, tumor lysis syndrome, and rhabdomyolysis.
- Examination of RRT's impact on fluid, electrolyte, acid-base balance, and toxin clearance.
Main Results:
- RRT aids in fluid, electrolyte, and acid-base homeostasis, and may modulate cytokines and clear endotoxins in sepsis.
- RRT effectively controls metabolic derangements by clearing endogenous toxins in inborn errors of metabolism, liver failure, and tumor lysis syndrome.
- RRT facilitates rapid extracorporeal clearance of exogenous toxins in drug overdose and addresses AKI in rhabdomyolysis.
Conclusions:
- Extracorporeal renal replacement therapy platforms have significant non-kidney applications in pediatric critical care.
- RRT plays a vital role in managing life-threatening conditions such as sepsis, metabolic crises, and toxic exposures in children.
- The review underscores the versatility of RRT in improving outcomes for critically ill children with diverse non-renal pathologies.
Abstract:
The utilization of extracorporeal renal replacement therapy (RRT), including continuous renal replacement therapy (CRRT) and hemodialysis (HD), beyond the treatment of volume overload and acute kidney injury (AKI) has witnessed a significant shift, demonstrating the potential to improve patient outcomes for a range of diseases. This comprehensive review explores the non-kidney applications for RRT platforms in critically ill children, focusing on diverse clinical scenarios such as sepsis, inborn errors of metabolism, liver failure, drug overdose, tumor lysis syndrome, and rhabdomyolysis. In the context of sepsis and septic shock, RRT not only facilitates fluid, electrolyte, and acid/base homeostasis, but may offer benefits in cytokine regulation, endotoxin clearance, and immunomodulation which may improve multi-organ dysfunction as well as hemodynamic challenges posed by this life-threatening condition. RRT modalities also have an important role in caring for children with inborn errors of metabolism, liver failure, and tumor lysis syndrome as they can control metabolic derangements with the efficient clearance of endogenous toxins in affected children. In cases of drug overdose, RRT is a crucial tool for rapid extracorporeal clearance of exogenous toxins, mitigating potential organ damage. The intricate interplay between liver failure and kidney function is examined, elucidating the role of RRT and plasma exchange in maintaining fluid and electrolyte balance when hepatic dysfunction complicates the clinical picture. Furthermore, RRT and HD are explored in the context of rhabdomyolysis, highlighting their utility in addressing AKI secondary to traumatic events and crush syndrome.
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