Continuous Renal Replacement Therapy: A Review of Use and Application in Pediatric Hematopoietic Stem Cell Transplant Recipients

Abstract

Hematopoietic stem cell transplant (HSCT) is a curative therapy for malignant and non-malignant conditions. However, complications post-HSCT contribute to significant morbidity and mortality in this population. Acute kidney injury (AKI) is common in the post-allogeneic transplant phase and contributes to morbidity in this population. Continuous renal replacement therapy (CRRT) is used often in the setting of AKI or multiorgan dysfunction in critically ill children. In addition, CRRT can be useful in many disease processes related to transplant and can potentially improve outcomes in this population. This review will focus on the use of CRRT in critically ill children in the post-HSCT setting outside the realm of acute renal failure and highlight the benefits and applications of this modality in this high-risk population.

Safety and efficacy of fluvoxamine in COVID‐19 ICU patients: An open label, prospective cohort trial with matched controls

“…This was shown to be 1.46 times more frequent in the treatment group ( n = 19), than in the control group ( n = 13), despite this difference being statistically nonsignificant ( P = .2). It is worth noting that CRRT can sometimes be used in sepsis 34 and for CAR‐T therapy 35 associated cytokine release syndrome with an aim of reducing circulating cytokine levels. Such a rationale might indicate that the higher incidence of CRRT in the fluvoxamine group was a confounding factor which could have assisted in removal of excess cytokines in intervention group patients thus improving their outcomes.…”

“…This was shown to be 1.46 times more frequent in the treatment group (n = 19), than in the control group (n = 13), despite this difference being statistically nonsignificant (P = .2). It is worth noting that CRRT can sometimes be used in sepsis 34 and for CAR-T therapy 35 4). Moreover, cytokine removal by means of CRRT remains nonselective, as both pro-and anti-inflammatory cytokines are eliminated, thereby limiting the usefulness of this treatment approach in COVID-19 patients.…”

Kidney Injury in Children after Hematopoietic Stem Cell Transplant

“…AKI is a relatively common complication after HCT, with a reported incidence rate of 21–84% [ 1 , 2 ]. Table 1 summarizes published studies reporting AKI in the pediatric HCT population [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ].…”

“…ICU mortality in children post HCT requiring CKRT is estimated to be 52–65% [ 2 , 49 ]. The 1-year overall survival rate is also poor (27.4% (95% CI: 16–40.5%, p < 0.0001)) [ 1 ].…”

“…The 1-year overall survival rate is also poor (27.4% (95% CI: 16–40.5%, p < 0.0001)) [ 1 ]. Reported factors that are associated with mortality include FO > 10%, mechanical ventilation, vasoactive support, and neutropenia at the end of CKRT [ 2 ].…”