Pediatric Renal Replacement Therapy in the Intensive Care UnitBridges B.C.a · Askenazi D.J.b · Smith J.b · Goldstein S.L.c
aVanderbilt University School of Medicine, Nashville, Tenn., bUniversity of Alabama at Birmingham, Birmingham, Ala., and cCincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Renal replacement therapy (RRT) is used in a wide variety of pediatric populations. In this article, we will review the advantages and disadvantages of the different RRT modalities and the technical aspects of providing pediatric RRT. In addition, we will review the use of RRT with extracorporeal membrane oxygenation, the use of continuous RRT in the critically ill child with acute kidney injury and fluid overload, and the use of RRT for the removal of toxins and treatment of inborn errors of metabolism.
© 2012 S. Karger AG, Basel
- Chesney RW: The development of pediatric nephrology. Pediatr Res 2002;52:770–778.
- Schaefer F, Warady BA: Peritoneal dialysis in children with end-stage renal disease. Nat Rev Nephrol 2011;7:659–668.
- Zaritsky J, Warady BA: Peritoneal dialysis in infants and young children. Semin Nephrol 2011;31:213–224.
- Symons JM, Chua AN, Somers MJ, Baum MA, Bunchman TE, Benfield MR, Brophy PD, Blowey D, Fortenberry JD, Chand D, Flores FX, Hackbarth R, Alexander SR, Mahan J, McBryde KD, Goldstein SL: Demographic characteristics of pediatric continuous renal replacement therapy: a report of the prospective pediatric continuous renal replacement therapy registry. Clin J Am Soc Nephrol 2007;2:732–738.
Fleming GM, Walters S, Goldstein SL, Alexander SR, Baum MA, Blowey DL, Bunchman TE, Chua AN, Fletcher SA, Flores FX, Fortenberry JD, Hackbarth R, McBryde K, Somers MJ, Symons JM, Brophy PD: Nonrenal indications for continuous renal replacement therapy: a report from the prospective pediatric continuous renal replacement therapy registry group. Pediatr Crit Care Med 2012, E-pub ahead of print.
- Goldstein SL: Pediatric acute renal failure: demographics and treatment. Contrib Nephrol 2004;144:284–290.
- Koralkar R, Ambalavanan N, Levitan EB, McGwin G, Goldstein S, Askenazi D: Acute kidney injury reduces survival in very low birth weight infant. Pediatr Res 2011;69:354–358.
- Blinder JJ, Goldstein SL, Lee VV, Baycroft A, Fraser CD, Nelson D, Jefferies JL: Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg 2012;143:368–374.
- Krawczeski CD, Woo JG, Wang Y, Bennett MR, Ma Q, Devarajan P: Neutrophil gelatinase-associated lipocalin concentrations predict development of acute kidney injury in neonates and children after cardiopulmonary bypass. J Pediatr 2011;158:1009–1015.e1.
- Askenazi DJ, Griffin R, McGwin G, Carlo W, Ambalavanan N: Acute kidney injury is independently associated with mortality in very low birthweight infants: a matched case-control analysis. Pediatr Nephrol 2009;24:991–997.
- Gadepalli SK, Selewski DT, Drongowski RA, Mychaliska GB: Acute kidney injury in congenital diaphragmatic hernia requiring extracorporeal life support: an insidious problem. J Pediatr Surg 2011;46:630–635.
- Kaur S, Jain S, Saha A, Chawla D, Parmar VR, Basu S, Kaur J: Evaluation of glomerular and tubular renal function in neonates with birth asphyxia. Ann Trop Paediatr 2011;31:129–134.
- Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL: Modified rifle criteria in critically ill children with acute kidney injury. Kidney Int 2007;71:1028–1035.
- Zappitelli M, Parikh CR, Akcan-Arikan A, Washburn KK, Moffett BS, Goldstein SL: Ascertainment and epidemiology of acute kidney injury varies with definition interpretation. Clin J Am Soc Nephrol 2008;3:948–954.
- Schneider J, Khemani R, Grushkin C, Bart R: Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med 2010;38:933–939.
- Santiago MJ, Lopez-Herce J, Urbano J, Solana MJ, del Castillo J, Ballestero Y, Botran M, Bellon JM: Clinical course and mortality risk factors in critically ill children requiring continuous renal replacement therapy. Intensive Care Med 2010;36:843–849.
- Fleming GM: Renal replacement therapy review: past, present and future. Organogenesis 2011;7:2–12.
- Chien JC, Hwang BT, Weng ZC, Meng LC, Lee PC: Peritoneal dialysis in infants and children after open heart surgery. Pediatr Neonatol 2009;50:275–279.
- Pedersen KR, Hjortdal VE, Christensen S, Pedersen J, Hjortholm K, Larsen SH, Povlsen JV: Clinical outcome in children with acute renal failure treated with peritoneal dialysis after surgery for congenital heart disease. Kidney Int Suppl 2008;108:S81–S86.
- Ricci Z, Morelli S, Vitale V, Di Chiara L, Cruz D, Picardo S: Management of fluid balance in continuous renal replacement therapy: technical evaluation in the pediatric setting. Int J Artif Organs 2007;30:896–901.
- Chan KL, Ip P, Chiu CS, Cheung YF: Peritoneal dialysis after surgery for congenital heart disease in infants and young children. Ann Thorac Surg 2003;76:1443–1449.
Xinjin L, Jianping X, Xiangdong S, Xia C: Peritoneal dialysis after repair of congenital heart disease in children. Chin Med Sci J 2003;18:100–104.
- Dittrich S, Vogel M, Dahnert I, Haas NA, Alexi-Meskishvili V, Lange PE: Acute hemodynamic effects of post cardiotomy peritoneal dialysis in neonates and infants. Intensive Care Med 2000;26:101–104.
- Sorof JM, Stromberg D, Brewer ED, Feltes TF, Fraser CD Jr: Early initiation of peritoneal dialysis after surgical repair of congenital heart disease. Pediatr Nephrol 1999;13:641–645.
Bojan M, Gioanni S, Vouhe PR, Journois D, Pouard P: Early initiation of peritoneal dialysis in neonates and infants with acute kidney injury following cardiac surgery is associated with a significant decrease in mortality. Kidney Int 2012, E-pub ahead of print.
Basu RK, Wheeler DS, Goldstein S, Doughty L: Acute renal replacement therapy in pediatrics. Int J Nephrol 2011;2011:785392.
- Nayak KS, Prabhu MV, Sinoj KA, Subhramanyam SV, Sridhar G: Peritoneal dialysis in developing countries. Contrib Nephrol 2009;163:270–277.
- Kaiser BA, Polinsky MS, Stover J, Morgenstern BZ, Baluarte HJ: Growth of children following the initiation of dialysis: a comparison of three dialysis modalities. Pediatr Nephrol 1994;8:733–738.
- Schaefer F, Straube E, Oh J, Mehls O, Mayatepek E: Dialysis in neonates with inborn errors of metabolism. Nephrol Dial Transplant 1999;14:910–918.
- Neu AM, Warady BA, Lederman HM, Furth SL, Fivush BA: Hypogammaglobulinemia in infants and young children maintained on peritoneal dialysis. Pediatric dialysis study consortium. Perit Dial Int 1998;18:440–443.
- Blake PG, Breborowicz A, Han DS, Joffe P, Korbet SM, Warady BA: Recommended peritoneal dialysis curriculum for nephrology trainees. The International Society for Peritoneal Dialysis (ISPD) Standards and Education Subcommittee. Perit Dial Int 2000;20:497–502.
- Quan A, Quigley R: Renal replacement therapy and acute renal failure. Curr Opin Pediatr 2005;17:205–209.
- Pazmino PA, Pazmino BP: Treatment of acute hypernatremia with hemodialysis. Am J Nephrol 1993;13:260–265.
- Patel N, Dalal P, Panesar M: Dialysis disequilibrium syndrome: a narrative review. Semin Dial 2008;21:493–498.
- Tolwani AJ, Wheeler TS, Wille KM: Sustained low-efficiency dialysis. Contrib Nephrol 2007;156:320–324.
- Maxvold NJ, Smoyer WE, Custer JR, Bunchman TE: Amino acid loss and nitrogen balance in critically ill children with acute renal failure: a prospective comparison between classic hemofiltration and hemofiltration with dialysis. Crit Care Med 2000;28:1161–1165.
- Brophy PD, Somers MJ, Baum MA, Symons JM, McAfee N, Fortenberry JD, Rogers K, Barnett J, Blowey D, Baker C, Bunchman TE, Goldstein SL: Multi-centre evaluation of anticoagulation in patients receiving continuous renal replacement therapy (CRRT). Nephrol Dial Transplant 2005;20:1416–1421.
- Goldstein SL: Advances in pediatric renal replacement therapy for acute kidney injury. Semin Dial 2011;24:187–191.
- Hackbarth R, Bunchman TE, Chua AN, Somers MJ, Baum M, Symons JM, Brophy PD, Blowey D, Fortenberry JD, Chand D, Flores FX, Alexander SR, Mahan JD, McBryde KD, Benfield MR, Goldstein SL: The effect of vascular access location and size on circuit survival in pediatric continuous renal replacement therapy: a report from the PPCRRT registry. Int J Artif Organs 2007;30:1116–1121.
Sutherland SM, Alexander SR: Continuous renal replacement therapy in children. Pediatr Nephrol 2012, E-pub ahead of print.
- Walters S, Porter C, Brophy PD: Dialysis and pediatric acute kidney injury: choice of renal support modality. Pediatr Nephrol 2009;24:37–48.
- Hackbarth RM, Eding D, Gianoli Smith C, Koch A, Sanfilippo DJ, Bunchman TE: Zero balance ultrafiltration (Z-BUF) in blood-primed CRRT circuits achieves electrolyte and acid-base homeostasis prior to patient connection. Pediatr Nephrol 2005;20:1328–1333.
- Kreuzer M, Bonzel KE, Buscher R, Offner G, Ehrich JH, Pape L: Regional citrate anticoagulation is safe in intermittent high-flux haemodialysis treatment of children and adolescents with an increased risk of bleeding. Nephrol Dial Transplant 2010;25:3337–3342.
- Chadha V, Garg U, Warady BA, Alon US: Citrate clearance in children receiving continuous venovenous renal replacement therapy. Pediatr Nephrol 2002;17:819–824.
Fleming GM, Askenazi DJ, Zappitelli M, Paden ML: RRT on ECMO study group: center practice survey results. 21st Annu Extracorp Life Support Organization Conf, St Petersburg, 2010.
- Sucosky P, Dasi LP, Goldman SL, Paden ML, Fortenberry JD, Yoganathan AP: Assessment of current continuous hemofiltration systems and development of a novel accurate fluid management system for use in extracorporeal membrane oxygenation. J Med Device 2008;2:35002–35010.
- Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Dart RC: 2010 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 28th annual report. Clin Toxicol (Phila) 2011;49:910–941.
- Bunchman TE, Ferris ME: Management of toxic ingestions with the use of renal replacement therapy. Pediatr Nephrol 2011;26:535–541.
- van Bommel EF, Kalmeijer MD, Ponssen HH: Treatment of life-threatening lithium toxicity with high-volume continuous venovenous hemofiltration. Am J Nephrol 2000;20:408–411.
- Meyer RJ, Flynn JT, Brophy PD, Smoyer WE, Kershaw DB, Custer JR, Bunchman TE: Hemodialysis followed by continuous hemofiltration for treatment of lithium intoxication in children. Am J Kidney Dis 2001;37:1044–1047.
- Vilay AM, Mueller BA, Haines H, Alten JA, Askenazi DJ: Treatment of methotrexate intoxication with various modalities of continuous extracorporeal therapy and glucarpidase. Pharmacotherapy 2010;30:111.
- Askenazi DJ, Goldstein SL, Chang IF, Elenberg E, Feig DI: Management of a severe carbamazepine overdose using albumin-enhanced continuous venovenous hemodialysis. Pediatrics 2004;113:406–409.
- Karvellas CJ, Bagshaw SM, McDermid RC, Stollery DE, Bain VG, Gibney RT: A case-control study of single-pass albumin dialysis for acetaminophen-induced acute liver failure. Blood Purif 2009;28:151–158.
- Sauer IM, Goetz M, Steffen I, Walter G, Kehr DC, Schwartlander R, Hwang YJ, Pascher A, Gerlach JC, Neuhaus P: In vitro comparison of the molecular adsorbent recirculation system (MARS) and single-pass albumin dialysis (SPAD). Hepatology 2004;39:1408–1414.
- Karvellas CJ, Bagshaw SM, McDermid RC, Stollery DE, Gibney RT: Acetaminophen-induced acute liver failure treated with single-pass albumin dialysis: report of a case. Int J Artif Organs 2008;31:450–455.
Peszynski P, Klammt S, Peters E, Mitzner S, Stange J, Schmidt R: Albumin dialysis: single pass vs recirculation (MARS). Liver 2002;22(suppl 2):40–42.
- Summar M: Current strategies for the management of neonatal urea cycle disorders. J Pediatr 2001;138:S30–S39.
- Picca S, Bartuli A, Dionisi-Vici C: Medical management and dialysis therapy for the infant with an inborn error of metabolism. Semin Nephrol 2008;28:477–480.
- McBryde KD, Kershaw DB, Bunchman TE, Maxvold NJ, Mottes TA, Kudelka TL, Brophy PD: Renal replacement therapy in the treatment of confirmed or suspected inborn errors of metabolism. J Pediatr 2006;148:770–778.
- Lai YC, Huang HP, Tsai IJ, Tsau YK: High-volume continuous venovenous hemofiltration as an effective therapy for acute management of inborn errors of metabolism in young children. Blood Purif 2007;25:303–308.
- Westrope C, Morris K, Burford D, Morrison G: Continuous hemofiltration in the control of neonatal hyperammonemia: a 10-year experience. Pediatr Nephrol 2010;25:1725–1730.
- Hoover NG, Heard M, Reid C, Wagoner S, Rogers K, Foland J, et al: Enhanced fluid management with continuous venovenous hemofiltration in pediatric respiratory failure patients receiving extracorporeal membrane oxygenation support. Intensive Care Med 2008;34:2241–2247.
- Santiago MJ, Sánchez A, López-Herce J, Pérez R, del Castillo J, Urbano J, Carrillo A: The use of continuous renal replacement therapy in series with extracorporeal membrane oxygenation. Kidney Int 2009;76:1289–1292.
- Selewski DT, Cornell TT, Lombel RM, Blatt NB, Han YY, Mottes T, Kommareddi M, Kershaw DB, Shanley TP, Heung M: Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy. Intensive Care Med 2011;37:1166–1173.
- Sutherland SM, Zappitelli M, Alexander SR, Chua AN, Brophy PD, Bunchman TE, Hackbarth R, Somers MJ, Baum M, Symons JM, Flores FX, Benfield M, Askenazi D, Chand D, Fortenberry JD, Mahan JD, McBryde K, Blowey D, Goldstein SL: Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis 2010;55: 316–325.
- Hayes LW, Oster RA, Tofil NM, Tolwani AJ: Outcomes of critically ill children requiring continuous renal replacement therapy. J Crit Care 2009;24:394-400.
- Goldstein SL, Somers MJ, Baum MA, Symons JM, Brophy PD, Blowey D, Bunchman TE, Baker C, Mottes T, McAfee N, Barnett J, Morrison G, Rogers K, Fortenberry JD: Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int 2005;67:653–658.
- Gillespie RS, Seidel K, Symons JM: Effect of fluid overload and dose of replacement fluid on survival in hemofiltration. Pediatr Nephrol 2004;19:1394–1399.
- Foland JA, Fortenberry JD, Warshaw BL, Pettignano R, Merritt RK, Heard ML, Rogers K, Reid C, Tanner AJ, Easley KA: Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis. Crit Care Med 2004;32:1771–1776.
- Goldstein SL, Currier H, Graf C, Cosio CC, Brewer ED, Sachdeva R: Outcome in children receiving continuous venovenous hemofiltration. Pediatrics 2001;107:1309–1312.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.