Pediatric continuous kidney replacement therapy: The Indonesian experience

Acute kidney injury (AKI) is a common complication in critically ill children, with continuous kidney replacement therapy (CKRT) as the key treatment, especially for hemodynamically unstable children. Although numerous studies have been conducted on CKRT, data from resource-constrained settings are scarce. Centers with more experience in CKRT tend to have better survival rates. This study aims to describe and analyze the characteristics of critically ill patients who received CKRT and examine the factors influencing CKRT outcomes in resource-limited settings.

A retrospective analysis was conducted on medical records from January 2015 to June 2023. Demographic data; clinical and laboratory profiles; hospitalization duration; use of inotropic support and mechanical ventilation; and the presence of sepsis, AKI, acute lung injury, acute respiratory distress syndrome, and encephalopathy were recorded and compared between survivors and non-survivors.

Fifty-six critically ill children underwent CKRT. The median age was 7.4 years, and the median body weight was 22.2 kg. CKRT was mostly indicated in sepsis-associated AKI (41.1%), nonsepsis AKI (23.2%), and acute-on-chronic kidney disease (21.4%). The median CKRT duration was 52.2 h, with median total delivered dose and mean blood flow rate per kilogram of 22.2 and 3.1 mL/kg/min, respectively. The overall survival rate was 25%.

Although patient demographics and CKRT prescriptions were like those at other centers, survival was low at our center because of considerable resource limitations. Despite challenges, CKRT remains the preferred treatment for critically ill children.