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Continuous veno-venous hemodiafiltration using bicarbonate dialysate
1Department of Nephrology, Women's and Children's Hospital, North Adelaide, South Australia.
Insights
Continuous veno-venous hemodiafiltration (CVVHDF) effectively treated 11 children, with 7 recovering normal kidney function. This pediatric renal replacement therapy demonstrated good control of metabolic acidosis.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Acute kidney injury (AKI) in children presents significant management challenges.
- Pediatric patients often require specialized renal replacement therapy (RRT) for severe AKI and multi-organ failure.
- Continuous veno-venous hemodiafiltration (CVVHDF) is an established RRT modality in critically ill adults, but its application in pediatrics requires careful consideration.
Purpose of the Study:
- To report the clinical experience and outcomes of CVVHDF in a cohort of pediatric patients.
- To evaluate the efficacy of CVVHDF in managing fluid balance, acid-base status, and uremic toxin clearance in children.
- To assess the recovery of renal function following CVVHDF treatment in this pediatric population.
Main Methods:
- Retrospective analysis of 11 pediatric patients treated with CVVHDF.
- Dual-lumen subclavian or femoral vein catheters were used for vascular access.
- Hemofilters were selected based on patient size and dialysis needs, utilizing bicarbonate-buffered solutions.
- Ultrafiltration rates, urea, and creatinine clearances were monitored.
Main Results:
- The median age of the 11 pediatric patients was 5.0 years (range: 3 days to 14 years).
- Mean ultrafiltration rate was 37.4 +/- 27 ml/kg/hr; urea and creatinine clearances were 15.1 +/- 6.4 ml/kg/min and 16.4 +/- 8.4 ml/kg/min, respectively.
- Metabolic acidosis was effectively controlled in all patients, and 7 out of 11 patients recovered normal renal function.
Conclusions:
- CVVHDF is a viable and effective treatment option for pediatric patients with acute kidney injury and fluid overload.
- The modality allows for adequate clearance of uremic toxins and effective management of metabolic derangements in children.
- A significant proportion of pediatric patients treated with CVVHDF can achieve recovery of renal function, highlighting its therapeutic potential.
Abstract:
We report our experience with 11 children treated by continuous veno-venous hemodiafiltration. The median age was 5.0 years (range 3 days to 14 years). Access was via dual-lumen subclavian or femoral vein catheters. Hemofilters were chosen on the basis of patient size and dialysis requirements. Bicarbonate-buffered dialysis solution was prepared shortly before use by supplementation of a specially prepared base solution with commercially available electrolyte solutions. The mean ultrafiltration rate was 37.4 +/- 27 ml/kg body weight per hour. Urea and creatinine clearances were 15.1 +/- 6.4 ml/kg body weight per min and 16.4 +/- 8.4 ml/kg body weight per min, respectively. Metabolic acidosis was readily controlled in all patients. Of the 11 patients, 7 ultimately recovered normal renal function.