Continuous renal replacement therapy in critically Ill pediatric patients

Abstract

The purpose of this article is to describe the experience with continuous renal replacement therapy (CRRT) in critically ill pediatric patients. From June 1985 to June 1995, 90 critically ill oliguric or anuric infants and children underwent continuous arteriovenous (n = 42) or venovenous (n = 48) renal support. Their mean age (± SEM) was 3.5 ± 0.5 years and their mean body weight (± SEM) was 14.9 ± 1.8 kg. The membrane surface area of the hemofilters ranged from 0.015 m 2 to 0.4 m 2, and the priming volume ranged from 3.7 to 38 mL. For pump-driven hemofiltration, a roller pump and small blood lines were used. Fluid balance was controlled by a microprocessor controlled unit. The ultrafiltrate substitution fluid was based on bicarbonate in the majority of the patients. During continuous hemodiafiltration, the bicarbonate-based dialysate fluid was administered countercurrent to blood flow. Mean duration of renal support (± SEM) was 134 ± 15 hours (range, 12 to 720). During arteriovenous and venovenous hemofiltration, the mean blood flow rates (± SEM) were 22.3 ± 3.9 mL/min and 40.4 ± 4.4 mL/min ( P < .01), respectively, and the mean ultrafiltration rates were 4.6 ± 0.5 and 9.7 ± 0.8 mL/min/m 2 ( P < .01), respectively. During continuous hemodiafiltration, urea clearances increased by 200% to 300%. Continuous hemofiltration either driven in the arteriovenous or venovenous mode is a very effective method of renal support for critically ill infants and children to control fluid balance and metabolic derangement. Continuous hemodiafiltration permits the highest clearance rates and is indicated in severe metabolic derangement.