Continuous renal replacement therapy in children up to 10 kg

Jordan M. Symons, Patrick D. Brophy, Melissa J. Gregory, Nancy McAfee, Michael J.G. Somers, Timothy E. Bunchman, Stuart L. Goldstein

Research output: Contribution to journalArticlepeer-review

102 Scopus citations

Abstract

Background: There is growing use of continuous renal replacement therapy (CRRT) for pediatric patients, but no large studies reporting CRRT use and outcome in young children. We describe a cohort of patients weighing 10 kg or less who underwent CRRT at five US children's hospitals between 1993 and 2001. Methods: We reviewed records of 85 patients weighing 10 kg or less who underwent at least 24 hours of CRRT. We evaluated weight, diagnosis, pressor number, CRRT characteristics, days on CRRT, and outcome (survival to leave intensive care unit versus death). Results: Patients weighed 1.5 to 10 kg (mean, 5.3 ± 2.8 kg; 16 patients ≤ 3 kg). Sixty-nine percent of patients were being administered pressors at the time of CRRT initiation, 88% of patients were administered heparin, and the others were administered citrate or no anticoagulation. Mean blood flow was 48 ± 24 mL/min (range, 15 to 106 mL/min) or 9.5 ± 4.2 mL/min/kg. Six hundred fifty-five patient-days of therapy were studied (mean, 7.6 ± 8.6 d/patient; range, 1 to 46 d/patient). Thirty-two patients (38%) survived; 4 of 16 patients (25%) weighing 3 kg or less survived. The smallest survivor weighed 2.3 kg. Overall, survivors and nonsurvivors showed no significant difference in weight, days on CRRT, or pressor number. However, for patients weighing more than 3 kg, 28 of 69 patients (41%) survived, and mean pressor number was lower for survivors versus nonsurvivors (0.96 ± 1.1 versus 1.6 ± 1.0 pressors; P < 0.03). Conclusion: CRRT is feasible and useful in children weighing 10 kg or less. Hemodynamic instability requiring pressor support neither precludes successful CRRT nor adversely affects survival. After CRRT, the survival rate in children who weigh 3 to 10 kg is similar to that in older children and adolescents.

Original languageEnglish
Pages (from-to)984-989
Number of pages6
JournalAmerican Journal of Kidney Diseases
Volume41
Issue number5
DOIs
StatePublished - May 1 2003

Keywords

  • Acute renal failure
  • Continuous renal replacement therapy (CRRT)
  • Infant
  • Newborn
  • Venovenous hemofiltration
  • Volume overload

Fingerprint

Dive into the research topics of 'Continuous renal replacement therapy in children up to 10 kg'. Together they form a unique fingerprint.

Cite this