Outcomes of critically ill children requiring continuous renal replacement therapy

Hayes, Leslie; Oster, Robert A.; Tofil, Nancy M.; Tolwani, Ashita J.

doi:10.1016/j.jcrc.2008.12.017

Cited by 190 publications

(103 citation statements)

References 24 publications

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“…Access was via internal jugular 6.5-French (Fr) hemodialysis catheters. Mean filter life was 51.1 h. Similar to other studies in pediatric CRRT patients [2][3][4]5], fluid overload (FO), defined by the percentage weight gain over weight at admission to the neonatal intensive care unit (NICU), was independently associated with mortality [6]. Neonatal studies have reported an FO of >15-20 % to be associated with poor outcome defined as need for CRRT, prolonged NICU stay, time to extubation or death within 30 days postcardiothoracic surgery [7,8].…”

supporting

confidence: 87%

Neonatal extracorporeal renal replacement therapy—a routine renal support modality?

2016

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Peritoneal dialysis (PD) is generally considered the preferred extracorporeal therapy for neonates with acute kidney injury (AKI). However, there are situations when PD is not suitable, such as in patients with previous abdominal surgery, hyperammonemia and significant ascites or anasarca. Additionally, with a need to start PD soon after catheter placement, there is increased risk of PD catheter leak and infection. Extracorporeal continuous renal replacement therapy (CRRT) is challenging in severely ill neonates as it requires obtaining adequately sized central venous access to accommodate adequate blood flow rates and also adaptation of a CRRT machine meant for older children and adults. In addition, ultrafiltration often cannot be set in sufficiently small increments to be suitable for neonates. Although CRRT practices can be modified to fit the needs of infants and neonates, there is a need for a device designed specifically for this population. Until that becomes available, providing the highest level of care for neonates with AKI is dependent on the shared experiences of members of the pediatric nephrology community.Keywords Extracorporeal continuous renal replacement therapy . Acute kidney injury . Neonates . nRIFLE . Continuous venovenous hemodiafiltrationIn a recent article in Pediatric Nephrology, Lee and Cho review their continuous renal replacement therapy (CRRT) experience in 34 neonates with acute kidney injury (AKI) [1]. Although single center and retrospective, there are several noteworthy characteristics of this study. The authors standardize neonatal AKI using the neonatal RIFLE (nRIFLE) criteria to define and stratify severity of AKI. Of the 34 neonates included in the study, 44 % were born preterm (25-36 weeks), with 60 % of these preterm infants being either extremely or very low birth weight. All patients had AKI, and 24 patients met the nRIFLE class F (Failure) criterion. Survival was 50 %. Continuous venovenous hemodiafiltration (CVVHDF) with Prisma or Prismaflex (Gambro/Baxter Int., Lund, Sweden) dialysis machines and M10 (50 ml) or HF20 (55 ml) filters was used for all CRRT treatments. Access was via internal jugular 6.5-French (Fr) hemodialysis catheters. Mean filter life was 51.1 h. Similar to other studies in pediatric CRRT patients [2-4, 5], fluid overload (FO), defined by the percentage weight gain over weight at admission to the neonatal intensive care unit (NICU), was independently associated with mortality [6]. Neonatal studies have reported an FO of >15-20 % to be associated with poor outcome defined as need for CRRT, prolonged NICU stay, time to extubation or death within 30 days postcardiothoracic surgery [7,8]. Interestingly, this study by Lee and Cho [1] reports a much higher FO cut-off of 30 % being associated with poor outcomes, including 100 % mortality for patients reaching an FO of >30 %. The authors propose higher body surface area, calorie consumption and insensible water loss in neonates as a possible explanation. They address this issue by using actual weig...

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confidence: 87%

Neonatal extracorporeal renal replacement therapy—a routine renal support modality?

2016

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“…It is recognised that RRT is associated with poor survival in children admitted to PICU for non-HSCT-related conditions, in particular if associated with sepsis or multiorgan dysfunction. 24,25 It has also been demonstrated that RRT is associated with poor outcome in paediatric oncology patients undergoing HSCT. 26 Although only a small number, those admitted with cardiovascular instability did particularly badly, with no survivors.…”

Section: Discussionmentioning

confidence: 99%

Outcome of children requiring intensive care following haematopoietic SCT for primary immunodeficiency and other non-malignant disorders

Cole

Johnstone

Pearce

et al. 2011

Bone Marrow Transplant

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Haematopoietic SCT (HSCT) is curative for many children with primary immunodeficiencies or other nonmalignant conditions. Outcome for those admitted to intensive care following HSCT for oncology diagnoses has historically been very poor. There is no literature available specifically regarding the outcome for children with primary immunodeficiency requiring intensive care following HSCT. We reviewed our post-HSCT admission to intensive care over a 5-year period. A total of 111 children underwent HSCT. Median age at transplant was 1 year 4 months. The most common diagnosis was SCID. In all, 35% had at least one intensive care admission and 44% survived to be discharged from intensive care. Also, 73% of admission episodes requiring invasive ventilation but no inotropes or renal replacement therapy resulted in survival to discharge. Children undergoing HSCT for immunological diagnoses had a high rate of admission to intensive care. No factors were identified that could predict the need for admission. Invasive ventilation alone has a much better outcome than that in historical series. However, the need for multi-organ system support was still associated with a poor outcome. This information is useful when counselling families of children that have deteriorated and been admitted to intensive care during the HSCT procedure.

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“…Higher AKI rates have striking implications, because AKI is associated with increased mortality and greater morbidity (4)(5)(6). In adults, a creatinine increase as modest as 0.3 mg/ dl is associated with a fourfold increase in mortality (4); critically ill pediatric patients with AKI severe enough to require dialysis experience mortality rates of 30%-50% (7,8). Children with AKI experience longer hospitalizations, prolonged intensive care unit (ICU) stays, and greater need for mechanical ventilation (6,9).…”

Section: Introductionmentioning

confidence: 99%

AKI in Hospitalized Children

Sutherland

Ji²,

Sheikhi³

et al. 2013

Clinical Journal of the American Society of Nephrology

224

161

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SummaryBackground and objectives Although AKI is common among hospitalized children, comprehensive epidemiologic data are lacking. This study characterizes pediatric AKI across the United States and identifies AKI risk factors using high-content/high-throughput analytic techniques.Design, setting, participants, & measurements For the cross-sectional analysis of the 2009 Kids Inpatient Database, AKI events were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Demographics, incident rates, and outcome data were analyzed and reported for the entire AKI cohort as well as AKI subsets. Statistical learning methods were applied to the highly imbalanced dataset to derive AKI-related risk factors.Results Of 2,644,263 children, 10,322 children developed AKI (3.9/1000 admissions). Although 19% of the AKI cohort was #1 month old, the highest incidence was seen in children 15-18 years old (6.6/1000 admissions); 49% of the AKI cohort was white, but AKI incidence was higher among African Americans (4.5 versus 3.8/1000 admissions). In-hospital mortality among patients with AKI was 15.3% but higher among children #1 month old (31.3% versus 10.1%, P,0.001) and children requiring critical care (32.8% versus 9.4%, P,0.001) or dialysis (27.1% versus 14.2%, P,0.001). Shock (odds ratio, 2.15; 95% confidence interval, 1.95 to 2.36), septicemia (odds ratio, 1.37; 95% confidence interval, 1.32 to 1.43), intubation/mechanical ventilation (odds ratio, 1.2; 95% confidence interval, 1.16 to 1.25), circulatory disease (odds ratio, 1.47; 95% confidence interval, 1.32 to 1.65), cardiac congenital anomalies (odds ratio, 1.2; 95% confidence interval, 1.13 to 1.23), and extracorporeal support (odds ratio, 2.58; 95% confidence interval, 2.04 to 3.26) were associated with AKI.Conclusions AKI occurs in 3.9/1000 at-risk US pediatric hospitalizations. Mortality is highest among neonates and children requiring critical care or dialysis. Identified risk factors suggest that AKI occurs in association with systemic/multiorgan disease more commonly than primary renal disease.

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Outcomes of critically ill children requiring continuous renal replacement therapy

Cited by 190 publications

References 24 publications

Neonatal extracorporeal renal replacement therapy—a routine renal support modality?

Neonatal extracorporeal renal replacement therapy—a routine renal support modality?

Outcome of children requiring intensive care following haematopoietic SCT for primary immunodeficiency and other non-malignant disorders

AKI in Hospitalized Children

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