Continuous renal replacement therapy (CRRT) in children : 14 years' experience in a single center in Korea, retrospective and comprehensive study

Abstract

Introduction: Continuous renal replacement therapy (CRRT) has been used as an important intervention in critically ill children with acute kidney injury (AKI). The objective of this study was to evaluate the clinical course of children receiving CRRT and to analyze the factors which lead to a need for CRRT or influence the outcome of CRRT. Method: This study is a retrospective single-center analysis including all patients admitted to the intensive care unit (ICU) of Severance hospital in South Korea, who under the treatment of a pediatric nephrologist and received CRRT between 2003 and 2016. We obtained the data for gender, age, weight, diagnosis, blood flow rate or type of CRRT machine used, indication for CRRT, administration of inotropic agents or anticoagulants, hours to initiating CRRT, and survival rate following CRRT. Result: Two hundred and ninety-one patients were identified and subsequently classified according to the primary disease. The mean age was 6.6 years (range 1.1 - 12.1 years) and the mean body weight was 23.2 kg (range 5.9 – 40.5 kg). The primary reasons for the initiation of CRRT were a combination of fluid overload, uremia, and oliguria (20.6%), oliguria only (15.8%), and uremia only (12.0%). The diagnoses before CRRT in these patients were renal disease (e.g. focal segmental glomerulosclerosis (FSGS), nephrotic syndrome, and hemolytic uremic syndrome), pure sepsis, and drug intoxication-. 86.4% of the patients survived after undergoing CRRT. The CRRT modalities included continuous veno-venous hemodiafiltration (CVVHDF) in 55.9% and continuous veno-venous hemodialysis (CVVHD) in 43.4% of the patients; PRISMA® was the most commonly used machine (80.8%). Mean CRRT duration was 5.8 days and the mean blood flow rate was 72.7 ml/min. 25% of the patients received nafamostat mesilate (Futhan®) and 1.4 % were switched to systemic heparin. The most common site of insertion of the initial hemo-catheter was left femoral (33.0%) and right femoral vein (31.9%). Twenty-one patients (7.8%) received extracorporeal membrane oxygenation (ECMO) and CRRT simultaneously. The overall survival rate was 31.2 %. More than one inotropic agents were infused in 70% of the patients and the non-survivors group (n=196) required them more than the survivors’ group did (n=93, p<0.001). Conclusion: Based on the 14 years of comprehensive experience at our center, we concluded that CRRT is an effective intervention for critically ill children with AKI or those with an underlying renal disease without significant complications.