Extracorporeal pediatric renal replacement therapy: diversifying application beyond kidney failure

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.