Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Continuous renal replacement therapy in neonates weighing less than 3 kg

  • Sohn, Young-Bae (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Paik, Kyung-Hoon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Cho, Hee-Yeon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Su-Jin (Department of Pediatrics, Myongji Hospital, Kwandong University College of Medicine) ;
  • Park, Sung-Won (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Eun-Sun (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chang, Yun-Sil (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Won-Soon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Yoon-Ho (Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jin, Dong-Kyu (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2011.11.01
  • Accepted : 2012.03.23
  • Published : 2012.08.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Continuous renal replacement therapy (CRRT) is becoming the treatment of choice for supporting critically ill pediatric patients. However, a few studies present have reported CRRT use and outcome in neonates weighing less than 3 kg. The aim of this study is to describe the clinical application, outcome, and complications of CRRT in small neonates. Methods: A retrospective review was performed in 8 neonatal patients who underwent at least 24 hours of pumped venovenous CRRT at the Samsung Medical Center in Seoul, Korea, between March 2007 and July 2010. Data, including demographic characteristics, diagnosis, vital signs, medications, laboratory, and CRRT parameters were recorded. Results: The data of 8 patients were analyzed. At the initiation of CRRT, the median age was 5 days (corrected age, $38^{+2}$ weeks to 23 days), and the median body weight was 2.73 kg (range, 2.60 to 2.98 kg). Sixty-two patient-days of therapy were reviewed; the median time for CRRT in each patient was 7.8 days (range, 1 to 37 days). Adverse events included electrolyte disturbances, catheter-related complications, and CRRT-related hypotension. The mean circuit functional survival was $13.9{\pm}8.6$ hours. Overall, 4 patients (50%) survived; the other 4 patients, who developed multiorgan dysfunction syndrome, died. Conclusion: The complications of CRRT in newborns are relatively high. However, the results of this study suggest that venovenous CRRT is feasible and effective in neonates weighing less than 3 kg under elaborate supportive care. Furthermore, for using potential benefit of CRRT in neonates, efforts are required for prolonging filter survival.

Keywords

References

  1. Warady BA, Bunchman T. Dialysis therapy for children with acute renal failure: survey results. Pediatr Nephrol 2000;15:11-3. https://doi.org/10.1007/s004670000420
  2. Symons JM, Brophy PD, Gregory MJ, McAfee N, Somers MJ, Bunchman TE, et al. Continuous renal replacement therapy in children up to 10 kg. Am J Kidney Dis 2003;41:984-9. https://doi.org/10.1016/S0272-6386(03)00195-1
  3. Goldstein SL, Somers MJ, Baum MA, Symons JM, Brophy PD, Blowey D, et al. Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int 2005;67:653-8. https://doi.org/10.1111/j.1523-1755.2005.67121.x
  4. Warady BA, Schaefer FS, Fine RN, Alexander SR. Pediatric dialysis. Dordrecht: Kluwer Academic Publishers, 2004.
  5. Walters S, Porter C, Brophy PD. Dialysis and pediatric acute kidney injury: choice of renal support modality. Pediatr Nephrol 2009;24:37-48. https://doi.org/10.1007/s00467-008-0826-x
  6. Bellomo R, Ronco C. Continuous haemofiltration in the intensive care unit. Crit Care 2000;4:339-45. https://doi.org/10.1186/cc718
  7. Ronco C, Bonello M, Bordoni V, Ricci Z, D'Intini V, Bellomo R, et al. Extracorporeal therapies in non-renal disease: treatment of sepsis and the peak concentration hypothesis. Blood Purif 2004;22:164-74. https://doi.org/10.1159/000074937
  8. Jouvet P, Jugie M, Rabier D, Desgres J, Hubert P, Saudubray JM, et al. Combined nutritional support and continuous extracorporeal removal therapy in the severe acute phase of maple syrup urine disease. Intensive Care Med 2001;27:1798-806. https://doi.org/10.1007/s00134-001-1124-2
  9. Thompson GN, Butt WW, Shann FA, Kirby DM, Henning RD, Howells DW, et al. Continuous venovenous hemofiltration in the management of acute decompensation in inborn errors of metabolism. J Pediatr 1991;118: 879-84. https://doi.org/10.1016/S0022-3476(05)82198-5
  10. Ponikvar R, Kandus A, Urbancic A, Kornhauser AG, Primozic J, Ponikvar JB. Continuous renal replacement therapy and plasma exchange in newborns and infants. Artif Organs 2002;26:163-8. https://doi.org/10.1046/j.1525-1594.2002.06838.x
  11. Bonilla-Felix M. Peritoneal dialysis in the pediatric intensive care unit setting. Perit Dial Int 2009;29 Suppl 2:S183-5.
  12. Teehan GS, Liangos O, Jaber BL. Update on dialytic management of acute renal failure. J Intensive Care Med 2003;18:130-8. https://doi.org/10.1177/0885066603251201
  13. Westrope C, Morris K, Burford D, Morrison G. Continuous hemofiltration in the control of neonatal hyperammonemia: a 10-year experience. Pediatr Nephrol 2010;25:1725-30. https://doi.org/10.1007/s00467-010-1549-3
  14. Schaefer F, Straube E, Oh J, Mehls O, Mayatepek E. Dialysis in neonates with inborn errors of metabolism. Nephrol Dial Transplant 1999;14:910-8. https://doi.org/10.1093/ndt/14.4.910
  15. Ronco C, Parenzan L. Acute renal failure in infancy: treatment by continuous renal replacement therapy. Intensive Care Med 1995;21:490-9. https://doi.org/10.1007/BF01706202
  16. Reeves JH, Butt WB, Sathe AS. A review of venovenous haemofiltration in seriously ill infants. J Paediatr Child Health 1994;30:50-4. https://doi.org/10.1111/j.1440-1754.1994.tb00566.x
  17. Jaing TH, Hsueh C, Tain YL, Hung IJ, Hsia SH, Kao CC. Tumor lysis syndrome in an infant with Langerhans cell histiocytosis successfully treated using continuous arteriovenous hemofiltration. J Pediatr Hematol Oncol 2001;23:142-4. https://doi.org/10.1097/00043426-200102000-00016
  18. Schroder CH, Severijnen RS, Potting CM. Continuous arteriovenous hemofiltration (CAVH) in a premature newborn as treatment of overhydration and hyperkalemia due to sepsis. Eur J Pediatr Surg 1992;2:368-9. https://doi.org/10.1055/s-2008-1063482
  19. Picca S, Dionisi-Vici C, Abeni D, Pastore A, Rizzo C, Orzalesi M, et al. Extracorporeal dialysis in neonatal hyperammonemia: modalities and prognostic indicators. Pediatr Nephrol 2001;16:862-7. https://doi.org/10.1007/s004670100702
  20. Leyh RG, Notzold A, Kraatz EG, Sievers HH, Bernhard A. Continuous venovenous haemofiltration in neonates with renal insufficiency resulting from low cardiac output syndrome after cardiac surgery. Cardiovasc Surg 1996;4:520-5. https://doi.org/10.1016/0967-2109(95)00125-5
  21. Jouvet P, Poggi F, Rabier D, Michel JL, Hubert P, Sposito M, et al. Continuous venovenous haemodiafiltration in the acute phase of neonatal maple syrup urine disease. J Inherit Metab Dis 1997;20:463-72. https://doi.org/10.1023/A:1005314025760
  22. Goldstein B, Giroir B, Randolph A; International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005;6:2-8. https://doi.org/10.1097/01.PCC.0000149131.72248.E6
  23. Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med 1996;24:743-52. https://doi.org/10.1097/00003246-199605000-00004
  24. Ronco C, Davenport A, Gura V. The future of the artificial kidney: moving towards wearable and miniaturized devices. Nefrologia 2011;31:9-16.
  25. Maclaren G, Butt W. Controversies in paediatric continuous renal replacement therapy. Intensive Care Med 2009;35:596-602. https://doi.org/10.1007/s00134-009-1425-4
  26. Santiago MJ, Lopez-Herce J, Urbano J, Solana MJ, del Castillo J, Ballestero Y, et al. Complications of continuous renal replacement therapy in critically ill children: a prospective observational evaluation study. Crit Care 2009; 13:R184. https://doi.org/10.1186/cc8172
  27. Choi G, Gomersall CD, Tian Q, Joynt GM, Freebairn R, Lipman J. Principles of antibacterial dosing in continuous renal replacement therapy. Crit Care Med 2009;37:2268-82. https://doi.org/10.1097/CCM.0b013e3181aab3d0
  28. del Castillo J, Lopez-Herce J, Cidoncha E, Urbano J, Mencia S, Santiago MJ, et al. Circuit life span in critically ill children on continuous renal replacement treatment: a prospective observational evaluation study. Crit Care 2008;12:R93. https://doi.org/10.1186/cc6965
  29. Goldstein SL, Hackbarth R, Bunchman TE, Blowey D, Brophy PD; Prospective Pediatric Crrt Registry Group Houston. Evaluation of the PRISMA M10 circuit in critically ill infants with acute kidney injury: a report from the Prospective Pediatric CRRT Registry Group. Int J Artif Organs 2006; 29:1105-8. https://doi.org/10.1177/039139880602901202
  30. Monchi M, Berghmans D, Ledoux D, Canivet JL, Dubois B, Damas P. Citrate vs. heparin for anticoagulation in continuous venovenous hemofiltration: a prospective randomized study. Intensive Care Med 2004;30:260-5. https://doi.org/10.1007/s00134-003-2047-x
  31. Kreuzer M, Ahlenstiel T, Kanzelmeyer N, Ehrich JH, Pape L. Management of regional citrate anticoagulation in pediatric high-flux dialysis: activated coagulation time versus post-filter ionized calcium. Pediatr Nephrol 2010; 25:1305-10. https://doi.org/10.1007/s00467-010-1483-4
  32. Brophy PD, Somers MJ, Baum MA, Symons JM, McAfee N, Fortenberry JD, et al. Multi-centre evaluation of anticoagulation in patients receiving continuous renal replacement therapy (CRRT). Nephrol Dial Transplant 2005;20:1416-21. https://doi.org/10.1093/ndt/gfh817
  33. Bunchman TE, Maxvold NJ, Barnett J, Hutchings A, Benfield MR. Pediatric hemofiltration: Normocarb dialysate solution with citrate anticoagulation. Pediatr Nephrol 2002;17:150-4. https://doi.org/10.1007/s00467-001-0791-0
  34. Ricci Z, Guzzo I, Picca S, Picardo S. Circuit lifespan during continuous renal replacement therapy: children and adults are not equal. Crit Care 2008;12:178. https://doi.org/10.1186/cc7000
  35. Hahn H, Park YS. Regional citrate anticoagulation for continuous renal replacement therapy in children. J Korean Soc Pediatr Nephrol 2005;9: 76-82.
  36. Shin JA, Choi YS, Jung HW, Lee YJ, Kang NR, Yang S, et al. Regional citrate anticoagulation in continuous venovenous hemodiafiltration: report of two cases. Korean J Nephrol 2006;25:447-51.
  37. Park JS, Kim GH, Kang CM, Lee CH. Regional anticoagulation with citrate is superior to systemic anticoagulation with heparin in critically Ill patients undergoing continuous venovenous hemodiafiltration. Korean J Intern Med 2011;26:68-75. https://doi.org/10.3904/kjim.2011.26.1.68
  38. Tolwani AJ, Wille KM. Anticoagulation for continuous renal replacement therapy. Semin Dial 2009;22:141-5. https://doi.org/10.1111/j.1525-139X.2008.00545.x
  39. Inagaki O, Nishian Y, Iwaki R, Nakagawa K, Takamitsu Y, Fujita Y. Adsorption of nafamostat mesilate by hemodialysis membranes. Artif Organs 1992;16:553-8.
  40. McBryde KD, Kershaw DB, Bunchman TE, Maxvold NJ, Mottes TA, Kudelka TL, et al. Renal replacement therapy in the treatment of confirmed or suspected inborn errors of metabolism. J Pediatr 2006;148: 770-8. https://doi.org/10.1016/j.jpeds.2006.01.004

Cited by

  1. Continuous Renal Replacement Therapy in Neonates vol.20, pp.1, 2012, https://doi.org/10.5385/nm.2013.20.1.12
  2. Citrate anticoagulation for continuous renal replacement therapy in small children vol.29, pp.3, 2012, https://doi.org/10.1007/s00467-013-2690-6
  3. 신생아와 영아의 지속적 신대체 요법 vol.18, pp.1, 2012, https://doi.org/10.3339/jkspn.2014.18.1.13
  4. Continuous Renal Replacement Therapy in the Neonatal Intensive Care Unit: A Single-Center Study vol.21, pp.4, 2012, https://doi.org/10.5385/nm.2014.21.4.244
  5. CVVHD treatment with CARPEDIEM: small solute clearance at different blood and dialysate flows with three different surface area filter configurations vol.31, pp.10, 2012, https://doi.org/10.1007/s00467-016-3397-2
  6. Renal replacement therapy in neonates with an inborn error of metabolism vol.62, pp.2, 2012, https://doi.org/10.3345/kjp.2018.07143
  7. Choice of Catheter Size for Infants in Continuous Renal Replacement Therapy : Bigger Is Not Always Better* vol.20, pp.3, 2012, https://doi.org/10.1097/pcc.0000000000001825
  8. Short-term results of continuous venovenous haemodiafiltration versus peritoneal dialysis in 40 neonates with inborn errors of metabolism vol.178, pp.6, 2012, https://doi.org/10.1007/s00431-019-03361-4
  9. A Case Series: Continuous Kidney Replacement Therapy in Neonates With Low Body Weight vol.9, pp.None, 2012, https://doi.org/10.3389/fped.2021.769220
  10. Review: Neonatal dialysis is technically feasible but ethical and global issues need to be addressed vol.110, pp.3, 2012, https://doi.org/10.1111/apa.15539