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Outcome of Continuous Renal Replacement Therapy in Children  

LIm, Yeon Jung (Department of Pediatrics, University of Ulsan, College of Medicine, Asan Medical Center)
Jin, Hyun-seung (Department of Pediatrics, University of Ulsan, College of Medicine, Asan Medical Center)
Hahn, Hyewon (Department of Pediatrics, University of Ulsan, College of Medicine, Asan Medical Center)
Oh, Sei Ho (Department of Pediatrics*, Handong University, Sunlin Hospital)
Park, Seong Jong (Department of Pediatrics, University of Ulsan, College of Medicine, Asan Medical Center)
Park, Young Seo (Department of Pediatrics, University of Ulsan, College of Medicine, Asan Medical Center)
Publication Information
Clinical and Experimental Pediatrics / v.48, no.1, 2005 , pp. 68-74 More about this Journal
Abstract
Purpose : There is growing use of continuous renal replacement therapy(CRRT) for pediatric patients, but reports about the use and outcome of CRRT in children is rare in Korea. We report our experiences of CRRT in critically ill pediatric patients. Methods : We reviewed the medical records of 23 pediatric patients who underwent CRRT at Asan Medical Center between May 2001 and May 2004. We evaluated underlying diseases, clinical features, treatment courses, CRRT modalities and outcomes. Results : Ages ranged from three days to 16 years with a median of five years. Patients weighed 2.4 to 63.9 kg(median 23.0 kg; 10 patients ${\leq}20kg$). The underlying diseases were malignancy(nine cases), multiple organ dysfunction syndrome(five cases), hyperammonemia(four cases), acute renal failure associated with liver failure(three cases), dilated cardiomyopathy(one case) and congenital nephrotic syndrome(one case). Pediatric Risk of Mortality(PRISM) III score was $17.6{\pm}7.6$ and the mean number of failing organs was $3.0{\pm}1.7$. Duration of CRRT was one to 27 days(median : nine days). Eleven patients(47.8%) survived. Chronic renal failure developed in two cases, intracranial hemorrhage in one case, and chylothorax in one case among the survivors. PRISM III score and the number of vasopressor before the start of CRRT was significantly lower in the survivors($12.7{\pm}4.2$ and $0.9{\pm}1.1$) compared with nonsurvivors($22.1{\pm}7.8$ and $2.4{\pm}1.4$)(P<0.05). Conclusion : CRRT driven in venovenous mode is an effective and safe method of renal support for critically-ill infants and children to control fluid balance and metabolic derangement. Survival is affected by PRISM III score and the number of vasopressors at the initiation of CRRT.
Keywords
Acute renal failure; Continuous renal replacement therapy; Children;
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1 Fleming F, Bohn D, Edwards H, Cox P, Geary D, Mc- Crindle BW, et al. Renal replacement therapy after repair of congenital heart disease in children : a comparison of hemofiltration and peritoneal dialysis. J Thoracic Cardiovasc Surg 1995;109:322-31.   DOI   PUBMED   ScienceOn
2 Pollack MM, Patel KM, Ruttimann UE. PRISM III : an updated pediatric risk of mortality score. Crit Care Med 1996; 24:743-52   DOI   ScienceOn
3 Symons JM, Brophy PD, Gregory MJ, McAfee N, Somers MJG, Bunchman TE, et al. Continuous renal replacement therapy in children up to 10 kg. Am J Kidney Dis 2003;41: 984-9   DOI   ScienceOn
4 Bunchman TE, Maxvold NJ, Kershaw DB, Sedman AB, Custer JR. Continuous venovenous hemodiafiltraion in infants and children. Am J Kidney Dis 1995;25:17-21   DOI   ScienceOn
5 Thomas MC, Harris DCH. Problems and advantages of continuous renal replacement therapy. Nephrology 2002;7: 110-4   DOI   ScienceOn
6 Morabito S, Guzzo I, Solazzo A, Muzi L, Luciani R, Pierucci A. Continuous renal replacement therapies : anticoagulation in the critically ill at high risk of bleeding. J Nephrol 2003;16:566-71
7 Maxvold NJ, Smoyer WE, Gardner JJ, Bunchman TE. Management of acute renal failure in the pediatric patient : hemofiltration versus hemodialysis. Am J Kidney Dis 1997;30(4 Suppl):84S-88S   DOI   ScienceOn
8 Ellis EN, Pearson D, Belsha CW, Berry PL. Use of pumpassisted hemofiltration in children with acute renal failure. Pediatr Nephrol 1997;11:196-200   DOI   ScienceOn
9 Lugones F, Chiotti G, Carrier M, Parent D, Thibodeau J, Ducharme B, et al. Continuous renal replacement therapy after cardiac surgery. Blood Purif 2004;22:249-55   DOI   ScienceOn
10 Goldstein SL. Overview of pediatric renal replacement therapy in acute renal failure. Artif Organs 2003;27:781-5   DOI   PUBMED   ScienceOn
11 Health and Public Policy Committee, American College of Physicians. Clinical competence in acute peritoneal dialysis. Ann Intern Med 1988;108:763-5   DOI   ScienceOn
12 Oda S, Hirasawa H, Shiga H, Nakanishi K, Matsuda K, Nakamura M. Continuous hemofiltration/hemodiafiltration in critical care. Ther Apher 2002;6:193-8   DOI   ScienceOn
13 Bunchman TE, McBryde KD, Mottes TE, Gardner JJ, Maxvold NJ, Brophy PD. Pediatric acute renal failure : outcome by modality and disease. Pediatr Nephrol 2001;16: 1067-71   DOI   ScienceOn
14 Flynn JT. Choice of dialysis modality for management of pediatric acute renal failure. Pediatr Nephrol 2002;17:61-9   DOI   ScienceOn
15 Swartz R, Pasko D, O'Toole J, Starmann B. Improving the delivery of continuous renal replacement therapy using regional citrate anticoagulation. Clin Nephrol 2004;61:134-43
16 Smoyer WE, McAdams C, Kaplan BS, Sherbotie JR. Determinants of survival in pediatric contiuous hemofiltration. J Am Soc Nephrol 1995;6:1401-9
17 Park SB. Continuous renal replacement therapy. Korean J Nephrol 1999;18 Suppl 1:44-54.
18 Storck M, Hartl WH, Zimmerer E, Inthorn D. Comparison of pump-driven and spontaneous continuous hemofiltraion in postoperative acute renal failure. Lancet 1991;337:452-5   DOI   ScienceOn
19 Warady BA, Bunchman T. Dialysis therapy for children with acute renal failure : survey results. Pediatr Nephrol 2000;15:11-3   DOI   ScienceOn
20 Lowrie LH. Renal replacement therapies in pediatric multiorgan dysfunction syndrome. Pediatr Nephrol 2000;14:6-12   DOI   ScienceOn
21 Zobel G, RIng E, Rodl S. Continuous renal replacement therapy in critically ill pediatric patients. Am J Kidney Dis 1996;28(3 Suppl):28S-34S   DOI   ScienceOn
22 Kang YS, Lee SY, Han SY, Jo SK, Shin JH, Cha DR, et al. The clinical characteristics of patients treated with continuous renal replacement therapy. Korean J Nephrol 2002;21:93-101
23 Andreoli SP. Acute renal failure. Curr Opin Pediatr 2002;14:183-188   DOI   PUBMED   ScienceOn
24 Lim YJ, Hahn H, Lee BS, Park YS. The experiences of pump-driven continuous venovenous hemofiltration therapy in pediatric patients. J Korean Soc Pediatr Nephrol 2002;6:251-8
25 van Bommel E, Bouvy ND, So KL, Ziestse R, Vincent HH, Bruining HA, et al. Acute dialytic support for the critically ill : intermittent hemodialysis versus continuous arteriovenous hemodiafiltraion. Am J Nephrol 1995;15:192-200   DOI   ScienceOn
26 Jang WK, Hahn H, Shin YR, Park HK, Kim AE, Park YS, et al. A case of continuous venovenous hemodiafiltration in the treatment of neonatal hyperammonemia due to methylmalonic acidemia. J Korean Soc Pediatr Nephrol 2003;7:96-102
27 Burchardi H. History and development of continuous renal replacement techniques. Kidney Int 1998;53 Suppl 66:120-4
28 Goldstein SL, Currier H, Graf JM, Cosio CC, Brewer ED, Sachdera R. Outcome in children receiving continuous venovenous hemofiltration. Pediatrics 2001;107:1309-12   DOI   ScienceOn
29 Michael M, Kuehnle I, Goldstein SL. Fluid overload and acute renal failure in pediatric stem cell transplant patients. Pediatr Nephrol 2004;19:91-5   DOI   ScienceOn