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McCulloch MI, Luyckx VA, Morrow B, Nourse P, Coetzee A, Reddy D, Du Buisson C, Buckley J, Webber I, Numanoglu A, Sinclair G, Nelson C, Salie S, Reichmuth K, Argent AC. Dialysis for paediatric acute kidney injury in Cape Town, South Africa. Pediatr Nephrol 2024; 39:2807-2818. [PMID: 38733539 PMCID: PMC11272748 DOI: 10.1007/s00467-024-06399-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Dialysis is lifesaving for acute kidney injury (AKI), but access is poor in less resourced settings. A "peritoneal dialysis (PD) first" policy for paediatric AKI is more feasible than haemodialysis in low-resource settings. METHODS Retrospective review of modalities and outcomes of children dialysed acutely at Red Cross War Memorial Children's Hospital between 1998 and 2020. RESULTS Of the 593 children with AKI who received dialysis, 463 (78.1%) received PD first. Median age was 9.0 (range 0.03-219.3; IQR 13.0-69.6) months; 57.6% were < 1 year old. Weights ranged from 0.9 to 2.0 kg (median 7.0 kg, IQR 3.0-16.0 kg); 38.6% were < 5 kg. PD was used more in younger children compared to extracorporeal dialysis (ECD), with median ages 6.4 (IQR 0.9-30.4) vs. 73.9 (IQR 17.5-113.9) months, respectively (p = 0.001). PD was performed with Seldinger soft catheters (n = 480/578, 83%), predominantly inserted by paediatricians at the bedside (n = 412/490, 84.1%). Complications occurred in 127/560 (22.7%) children receiving PD. Overall, 314/542 (57.8%) children survived. Survival was significantly lower in neonates (< 1 month old, 47.5%) and infants (1-12 months old, 49.2%) compared with older children (> 1 year old, 70.4%, p < 0.0001). Survival was superior in the ECD (75.4%) than in the PD group (55.6%, p = 0.002). CONCLUSIONS "PD First for Paediatric AKI" is a valuable therapeutic approach for children with AKI. It is feasible in low-resourced settings where bedside PD catheter insertion can be safely taught and is an acceptable dialysis modality, especially in settings where children with AKI would otherwise not survive.
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Affiliation(s)
- Mignon I McCulloch
- Red Cross War Memorial Children's Hospital (RCWMCH), Rondebosch, Cape Town, South Africa.
- University of Cape Town, Cape Town, South Africa.
| | | | | | - Peter Nourse
- Red Cross War Memorial Children's Hospital (RCWMCH), Rondebosch, Cape Town, South Africa
- University of Cape Town, Cape Town, South Africa
| | - Ashton Coetzee
- Red Cross War Memorial Children's Hospital (RCWMCH), Rondebosch, Cape Town, South Africa
- University of Cape Town, Cape Town, South Africa
| | - Deveshni Reddy
- Red Cross War Memorial Children's Hospital (RCWMCH), Rondebosch, Cape Town, South Africa
- University of Cape Town, Cape Town, South Africa
| | - Christel Du Buisson
- Tygerberg Children's Hospital, University of Stellenbosch, Stellenbosch, South Africa
| | - Jonathan Buckley
- Red Cross War Memorial Children's Hospital (RCWMCH), Rondebosch, Cape Town, South Africa
- University of Cape Town, Cape Town, South Africa
| | - Ilana Webber
- University of Cape Town, Cape Town, South Africa
| | | | - Gina Sinclair
- Red Cross War Memorial Children's Hospital (RCWMCH), Rondebosch, Cape Town, South Africa
- University of Cape Town, Cape Town, South Africa
| | - Candice Nelson
- Red Cross War Memorial Children's Hospital (RCWMCH), Rondebosch, Cape Town, South Africa
- University of Cape Town, Cape Town, South Africa
| | - Shamiel Salie
- Red Cross War Memorial Children's Hospital (RCWMCH), Rondebosch, Cape Town, South Africa
- University of Cape Town, Cape Town, South Africa
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Huang JX, Williams JAJ, Hsu RK. Continuous Kidney Replacement Therapy in Pediatric Intensive Care Unit: Little People, Big Gaps. Am J Kidney Dis 2024:S0272-6386(24)00866-7. [PMID: 39093241 DOI: 10.1053/j.ajkd.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 06/24/2024] [Accepted: 06/28/2024] [Indexed: 08/04/2024]
Affiliation(s)
- Jia Xin Huang
- Division of Pediatric Critical Care, University of California, San Francisco, San Francisco, California
| | | | - Raymond K Hsu
- Division of Nephrology, University of California, San Francisco, San Francisco, California.
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Nie A, Zhang S, Cai M, Yu L, Li J, Su X. Incidence and associated factors for hypotension during continuous renal replacement therapy in critically ill patients. Int J Nurs Pract 2024:e13296. [PMID: 39075855 DOI: 10.1111/ijn.13296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/01/2024] [Accepted: 07/17/2024] [Indexed: 07/31/2024]
Abstract
AIMS This work aimed to analyse retrospective data on hypotension incidence and associated factors among patients requiring continuous renal replacement therapy. BACKGROUND The incidence and risk factors of continuous renal replacement therapy-related hypotension have not been adequately explored. DESIGN The study was designed as a retrospective analysis. METHODS Patients who required continuous renal replacement therapy in the ICU between January 2017 and June 2021 were reviewed. The multivariate logistic regression model was used to determine the associated factors of hypotension. RESULTS Hypotension occurred in 242 out of 885 circuits (27.3%) among 140 patients. The logistic regression analysis identified seven factors associated with the occurrence of hypotension during CRRT: serum albumin (OR = 0.969, 95%CI: 0.934-0.999), serum calcium (OR = 0.514, 95%CI: 0.345-0.905), CO2CP (OR = 0.933, 95%CI: 0.897-0.971), use of vasopressors (OR = 5.731, 95%CI: 4.023-8.165), hypotension before CRRT initiation (OR = 2.779, 95%CI:1.238-6.242), age (OR = 1.016, 95%CI: 1.005-1.027), and fluid removal rate (OR = 1.002, 95%CI: 1.001-1.003). CONCLUSIONS Hypotension frequently occurs in patients receiving continuous renal replacement therapy, especially in the early stages. Multiple factors can be associated with cardiac output or peripheral resistance changes, including excessive ultrafiltration, vasopressors, serum albumin and serum calcium levels, and carbon dioxide combining power.
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Affiliation(s)
- Anliu Nie
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shuzeng Zhang
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingju Cai
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Limei Yu
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianfeng Li
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiangfen Su
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Figueiredo C, Rocha AM, Correia-Costa L, Faria MDS, Costa T, Mota C. Acute kidney injury: the experience of a tertiary center of Pediatric Nephrology. J Bras Nefrol 2024; 46:e20240012. [PMID: 38748945 PMCID: PMC11299983 DOI: 10.1590/2175-8239-jbn-2024-0012en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/12/2024] [Indexed: 07/15/2024] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) is an abrupt deterioration of kidney function. The incidence of pediatric AKI is increasing worldwide, both in critically and non-critically ill settings. We aimed to characterize the presentation, etiology, evolution, and outcome of AKI in pediatric patients admitted to a tertiary care center. METHODS We performed a retrospective observational single-center study of patients aged 29 days to 17 years and 365 days admitted to our Pediatric Nephrology Unit from January 2012 to December 2021, with the diagnosis of AKI. AKI severity was categorized according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The outcomes considered were death or sequelae (proteinuria, hypertension, or changes in renal function at 3 to 6 months follow-up assessments). RESULTS Forty-six patients with a median age of 13.0 (3.5-15.5) years were included. About half of the patients (n = 24, 52.2%) had an identifiable risk factor for the development of AKI. Thirteen patients (28.3%) were anuric, and all of those were categorized as AKI KDIGO stage 3 (p < 0.001). Almost one quarter (n = 10, 21.7%) of patients required renal replacement therapy. Approximately 60% of patients (n = 26) had at least one sequelae, with proteinuria being the most common (n = 15, 38.5%; median (P25-75) urinary protein-to-creatinine ratio 0.30 (0.27-0.44) mg/mg), followed by reduced glomerular filtration rate (GFR) (n = 11, 27.5%; median (P25-75) GFR 75 (62-83) mL/min/1.73 m2). CONCLUSIONS Pediatric AKI is associated with substantial morbidity, with potential for proteinuria development and renal function impairment and a relevant impact on long-term prognosis.
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Affiliation(s)
- Carolina Figueiredo
- Hospital do Divino Espírito Santo de Ponta Delgada, Serviço de Pediatria, Ilha de São Miguel, Portugal
| | - Ana Margarida Rocha
- Universidade do Porto, Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Liane Correia-Costa
- Universidade do Porto, Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
- Centro Hospitalar Universitário de Santo António, Centro Materno-Infantil do Norte, Unidade de Nefrologia Pediátrica, Porto, Portugal
- Universidade do Porto, Instituto de Saúde Pública (EPIUnit), Porto, Portugal
- Universidade do Porto, Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Maria do Sameiro Faria
- Centro Hospitalar Universitário de Santo António, Centro Materno-Infantil do Norte, Unidade de Nefrologia Pediátrica, Porto, Portugal
- Universidade do Porto e Universidade NOVA de Lisboa, Unidade de Ciências Biomoleculares Aplicadas (UCIBIO), Lisboa, Portugal
| | - Teresa Costa
- Centro Hospitalar Universitário de Santo António, Centro Materno-Infantil do Norte, Unidade de Nefrologia Pediátrica, Porto, Portugal
| | - Conceição Mota
- Centro Hospitalar Universitário de Santo António, Centro Materno-Infantil do Norte, Unidade de Nefrologia Pediátrica, Porto, Portugal
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Bao NT, Luan VT, Liem BT, Nhu VHT, Viet DC, Tung TH, Burza S, Thanh NT. Extracorporeal life support and continuous renal replacement therapy in a patient with Enterovirus A71 associated cardiopulmonary failure: A case report. Medicine (Baltimore) 2024; 103:e36797. [PMID: 38181280 PMCID: PMC10766259 DOI: 10.1097/md.0000000000036797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/06/2023] [Indexed: 01/07/2024] Open
Abstract
RATIONALE Hand-foot-mouth disease (HFMD) caused by Enterovirus A71, complicated by cardiopulmonary failure, is associated with a high mortality rate despite intensive treatment. To date, there is a paucity of clinical management data, regarding the use of extracorporeal life support (VA-ECMO) for Enterovirus-A71 associated cardiopulmonary failure reported. PATIENT CONCERNS The patient in this study presented with severe HFMD complicated by cardiopulmonary failure, polymorphic ventricular tachycardia, and cardiac arrest. DIAGNOSES Clinical presentations, laboratory data, and polymerase chain reaction (PCR) results from rectal swabs were used to confirm the diagnosis of severe HFMD caused by Enterovirus A71. INTERVENTIONS The patient was managed with chest compression and an automatic external defibrillator, mechanical ventilation, intravenous immunoglobulin (IVIG), continuous renal replacement therapy (CRRT) and inotrope (milrinone). The patient did not respond to these interventions and subsequently required further management with VA-ECMO. OUTCOMES The patient achieved a favorable outcomes. LESSONS Our study highlights that extracorporeal membrane oxygenation and CRRT can enhance the survival outcomes of patients with severe HFMD with cardiopulmonary failure complications. Furthermore, we propose specific indications for the initiation of VA-ECMO.
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Affiliation(s)
- Nguyen Trung Bao
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
| | - Vo Thanh Luan
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
| | - Bui Thanh Liem
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
- Faculty of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | - Do Chau Viet
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
| | - Trinh Huu Tung
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
| | - Sakib Burza
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Health in Harmony, London, United Kingdom
| | - Nguyen Tat Thanh
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Woolcock Institute of Medical Research, Ho Chi Minh City, Vietnam
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Duarsa GWK, Sugianto R, Tirtayasa PMW, Saniti NMA, Duarsa KHA. The prophylactic omentectomy procedure in reducing the complication rate of continuous ambulatory peritoneal dialysis in pediatric: A systematic review and meta-analysis. Arch Ital Urol Androl 2023; 95:12049. [PMID: 38059270 DOI: 10.4081/aiua.2023.12049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/11/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION The role of the omentectomy procedure on Continuous Ambulatory Peritoneal Dialysis (CAPD) catheter placement in pediatric patients has been differently evaluated in the literature, with some studies showing improvement while others showing no difference. Our study aims to define the advantages of omentectomy compared to a procedure without omentectomy. METHODS The literature searching in online databases (PubMed/MEDLINE, Cochrane Library, EMBASE, Scopus, and ClinicalTrial.gov) following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, has been registered on PROSPERO (CRD42023412846). The protocol was performed through April 2023 and focused on pediatric patients treated with an omentectomy procedure and related complications. The risk of bias in each study was assessed using the risk of bias for the non-randomized control trials (ROBINS-I). The effect estimates were extracted as risk ratios with 95% confidence intervals (CI). The heterogeneity of the studies was considered as high heterogeneity if I2 values above 50% or p < 0.05. RESULTS In the total of 676 articles identified in the database searching for screening, nine studies with 775 patients met the criteria for inclusion. The omentectomy procedure significantly showed a lower incidence of catheter obstruction compared to the control group, (OR 0.24 [95% CI, 0.12-0.49], p < 0.0001, I2 = 0%). Moreover, omentectomy demonstrated a similar trend in the rate of removal or reinsertion of the catheter with high heterogeneity, OR 0.25 [95% CI, 0.12-0.51), p = 0.0002, I2 = 70%). CONCLUSIONS The omentectomy procedure showed a lower incidence of catheter obstruction and complications leading to removal or reinsertion of the catheter.
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Affiliation(s)
- Gede Wirya Kusuma Duarsa
- Department of Urology, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G Ngoerah General Hospital, Bali.
| | - Ronald Sugianto
- Medical Doctor Study Program, Faculty of Medicine, Universitas Udayana, Bali.
| | - Pande Made Wisnu Tirtayasa
- Department of Urology, Faculty of Medicine, Universitas Udayana, Universitas Udayana Teaching Hospital, Bali.
| | - Ni Made Apriliani Saniti
- Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G Ngoerah General Hospital, Bali.
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Gülçek ÖN, Gülhan B, Kesici S, Kurt Şükür ED, Hayran M, Ozaltin F, Duzova A, Bayrakçı B, Topaloglu R. Long-term kidney follow-up after pediatric acute kidney support therapy for children less than 15 kg. Pediatr Nephrol 2023; 38:3811-3821. [PMID: 37195543 PMCID: PMC10189211 DOI: 10.1007/s00467-023-06013-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND In small children, acute dialysis (pediatric acute kidney support therapy (paKST)) is increasingly used; however, it is challenging for many reasons. We compared clinical characteristics and predictors of long-term outcomes of patients < 15 kg on peritoneal dialysis (PD), hemodialysis (HD), and continuous kidney replacement therapy (CKRT). METHODS Patients with history of paKST (CKRT, HD, PD) weighing < 15 kg and ≥ 6 months of follow-up at Hacettepe University were included. Surviving patients were evaluated at last visit. RESULTS 109 patients (57 females) were included. Median age at paKST was 10.1 months (IQR: 2-27 months). In total, 43 (39.4%) patients received HD, 37 (34%) PD, and 29 (26.6%) CKRT. 64 (58.7%) patients died a median 3 days (IQR: 2-9.5 days) after paKST. Percentages of patients using vasopressor agents, with sepsis, and undergoing mechanical ventilation were lower in those who survived. After mean follow-up of 2.9 ± 2.1 years, 34 patients were evaluated at mean age 4.7 ± 2.4 years. Median spot urine protein/creatinine was 0.19 (IQR: 0.13-0.37) and 12 patients (35.3%) had non-nephrotic proteinuria. Three patients had estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73m2 and 2 (6%) had hyperfiltration. In total 22 patients (64.7%) had ≥ 1 kidney risk factor (elevated blood pressure/hypertension, hyperfiltration, eGFR < 90 ml/min/1.73m2, and/or proteinuria) at last visit. Among 28 patients on paKST < 32 months, 21 had ≥ 1 risk factor (75%), whereas among 6 patients who had paKST ≥ 32 months, one patient had ≥ 1 risk factor (16.7%), (p = 0.014). CONCLUSIONS Patients on paKST who undergo mechanical ventilation and vasopressor treatment should be followed-up more closely. After surviving the acute period, patients on paKST need to be followed-up closely during the chronic stage. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Ömer Nazım Gülçek
- Faculty of Medicine, Department of Pediatrics, Hacettepe University, Ankara, Türkiye
| | - Bora Gülhan
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Hacettepe University, Sihhiye, Ankara, Türkiye.
| | - Selman Kesici
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Intensive Care Medicine, Life Support Center, Hacettepe University, Ankara, Türkiye
| | - Eda Didem Kurt Şükür
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Hacettepe University, Sihhiye, Ankara, Türkiye
| | - Mutlu Hayran
- Department of Preventive Oncology, Hacettepe University, Ankara, Türkiye
| | - Fatih Ozaltin
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Hacettepe University, Sihhiye, Ankara, Türkiye
- Nephrogenetics Laboratory, Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University, Ankara, Türkiye
- Department of Bioinformatics, Institute of Health Sciences, Hacettepe University, Ankara, 06100, Türkiye
| | - Ali Duzova
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Hacettepe University, Sihhiye, Ankara, Türkiye
| | - Benan Bayrakçı
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Intensive Care Medicine, Life Support Center, Hacettepe University, Ankara, Türkiye
| | - Rezan Topaloglu
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Hacettepe University, Sihhiye, Ankara, Türkiye
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Vo LT, Do VC, Trinh TH, Vu T, Nguyen TT. Combined Therapeutic Plasma Exchange and Continuous Renal Replacement Therapy in Children With Dengue-Associated Acute Liver Failure and Shock Syndrome: Single-Center Cohort From Vietnam. Pediatr Crit Care Med 2023; 24:818-828. [PMID: 37310173 PMCID: PMC10540756 DOI: 10.1097/pcc.0000000000003304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Pediatric acute liver failure (PALF) is a fatal complication in patients with severe dengue. To date, clinical data on the combination of therapeutic plasma exchange (TPE) and continuous renal replacement therapy (CRRT) for managing dengue-associated PALF concomitant with shock syndrome are limited. DESIGN Retrospective cohort study (January 2013 to June 2022). PATIENTS Thirty-four children. SETTING PICU of tertiary Children's Hospital No. 2 in Vietnam. INTERVENTIONS We assessed a before-versus-after practice change at our center of using combined TPE and CRRT (2018 to 2022) versus CRRT alone (2013 to 2017) in managing children with dengue-associated acute liver failure and shock syndrome. Clinical and laboratory data were reviewed from PICU admission, before and 24 h after CRRT and TPE treatments. The main study outcomes were 28-day in-hospital mortality, hemodynamics, clinical hepatoencephalopathy, and liver function normalization. MEASUREMENTS AND MAIN RESULTS A total of 34 children with a median age of 10 years (interquartile range: 7-11 yr) underwent standard-volume TPE and/or CRRT treatments. Combined TPE and CRRT ( n = 19), versus CRRT alone ( n = 15), was associated with lower proportion of mortality 7 of 19 (37%) versus 13 of 15 (87%), difference 50% (95% CI, 22-78; p < 0.01). Use of combined TPE and CRRT was associated with substantial advancements in clinical hepatoencephalopathy, liver transaminases, coagulation profiles, and blood lactate and ammonia levels (all p values < 0.001). CONCLUSIONS In our experience of children with dengue-associated PALF and shock syndrome, combined use of TPE and CRRT, versus CRRT alone, is associated with better outcomes. Such combination intervention was associated with normalization of liver function, neurological status, and biochemistry. In our center we continue to use combined TPE and CRRT rather than CRRT alone.
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Affiliation(s)
- Luan Thanh Vo
- Infectious Disease Department, Children Hospital 2, Ho Chi Minh City, Vietnam
| | - Viet Chau Do
- Infectious Disease Department, Children Hospital 2, Ho Chi Minh City, Vietnam
| | - Tung Huu Trinh
- Infectious Disease Department, Children Hospital 2, Ho Chi Minh City, Vietnam
| | - Thien Vu
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Shiga, Japan
- AI Nutrition Project, National Institutes of Biomedical Innovation, Health and Nutrition, (NIBIOHN), Ibaraki, Osaka, Japan
| | - Thanh Tat Nguyen
- Infectious Disease Department, Children Hospital 2, Ho Chi Minh City, Vietnam
- Woolcock Institute of Medical Research, Ho Chi Minh City, Vietnam
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Kedarnath M, Alexander EC, Deep A. Safety and efficacy of continuous renal replacement therapy for children less than 10 kg using standard adult machines. Eur J Pediatr 2023; 182:3619-3629. [PMID: 37233776 PMCID: PMC10460307 DOI: 10.1007/s00431-023-05007-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023]
Abstract
Continuous Renal Replacement Therapy (CRRT) machines are used off-label in patients less than 20 kg. Infant and neonates-dedicated CRRT machines are making their way into current practice, but these machines are available only in select centres. This study assesses the safety and efficacy of CRRT using adult CRRT machines in children ≤ 10 kg and to determines the factors affecting the circuit life in these children. DESIGN Retrospective cohort study of children ≤ 10 kg who received CRRT (January 2010-January 2018) at a PICU in a tertiary care centre in London, UK. Primary diagnosis, markers for illness severity, CRRT characteristics, length of PICU admission and survival to PICU discharge were collected. Descriptive analysis compared survivors and non-survivors. A subgroup analysis compared children ≤ 5 kg to children 5-10 kg. Fifty-one patients ≤ 10 kg received 10,328 h of CRRT, with median weight of 5 kg. 52.94% survived to hospital discharge. Median circuit life was 44 h (IQR 24-68). Bleeding episodes occurred with 6.7% of sessions and hypotension for 11.9%. Analysis of efficacy showed a reduction in fluid overload at 48 h (P = 0.0002) and serum creatinine at 24 and 48 h (P = 0.001). Blood priming was deemed to be safe as serum potassium decreased at 4 h (P = 0.005); there was no significant change in serum calcium. Survivors had a lower PIM2 score at PICU admission (P < 0.001) and had longer PICU length of stay (P < 0.001). Conclusion: Pending neonatal and infant dedicated CRRT machines, CRRT can be safely and effectively applied to children weighing ≤ 10 kg using adult-sized CRRT machines. WHAT IS KNOWN • Continuous Renal Replacement Therapy can be used for a variety of renal and non-renal indications to improve outcomes for children in the paediatric intensive care unit. These include, persistent oliguria, fluid overload, hyperkalaemia, metabolic acidosis, hyperlactatemia, hyperammonaemia, and hepatic encephalopathy. • Young children ≤ 10 kg are most often treated using standard adult machines, off-label. This potentially places them at risk of side effects due to high extracorporeal circuit volumes, relatively higher blood flows, and difficulty in achieving vascular access. WHAT IS NEW • This study found that standard adult machines were effective in reducing fluid overload and creatinine in children ≤ 10 kg. This study also assessed safety of blood priming in this group and found no evidence of an acute fall in haemoglobin or calcium, and a fall in serum potassium by a median of 0.3 mmol/L. The frequency of bleeding episodes was 6.7%, and hypotension requiring vasopressors or fluid resuscitation occurred with 11.9% of treatment sessions. • These findings suggest that adult CRRT machines are sufficiently safe and efficacious for routine use in PICU for children ≤ 10 kg and suggest that further research is undertaken, regarding the routine rollout of dedicated machines.
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Affiliation(s)
- Manju Kedarnath
- Paediatric Intensive Care Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Emma C Alexander
- Paediatric Intensive Care Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Akash Deep
- Paediatric Intensive Care Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.
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David VL, Mussuto E, Stroescu RF, Gafencu M, Boia ES. Peritoneal Dialysis Catheter Placement in Children: Initial Experience with a "2+1"-Port Laparoscopic-Assisted Technique. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050961. [PMID: 37241193 DOI: 10.3390/medicina59050961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
The placement of a peritoneal dialysis catheter (PDC) is currently a common procedure in pediatric surgeon practice, and the search for the ultimate technique never stops. The purpose of this study is to evaluate our experience with the laparoscopic PDC placement approach, performing a "2+1" ("two plus one") technique, where the "+1" trocar is placed in an oblique manner, pointing toward the Douglas pouch when passing through the abdominal wall. This tunnel is further used to place and maintain the proper position of the PDC. MATERIALS AND METHODS We assessed a cohort of five children who underwent laparoscopic-assisted PDC placement between 2018 and 2022. RESULTS This procedure is a simple, relatively quick, and safe technique for PDC placement. Furthermore, in our experience, concomitant omentectomy is necessary to reduce the risk of catheter obstruction and migration due to omental wrapping. CONCLUSIONS The laparoscopic approach allows for improved visualization and more accurate placement of a catheter inside the abdominal cavity. Concomitant omental excision is necessary to prevent PDC malfunction and migration.
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Affiliation(s)
- Vlad-Laurentiu David
- Department of Pediatric Surgery and Orthopedics, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Elisa Mussuto
- Department of Pediatric Surgery, Fondazione I.R.C.C.S. Policlinico San Matteo, Via Forlanini, 16, 27100 Pavia, PV, Italy
| | - Ramona-Florina Stroescu
- Departments of Pediatrics, "Victor Babes" University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu, 300041 Timisoara, Romania
| | - Mihai Gafencu
- Departments of Pediatrics, "Victor Babes" University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu, 300041 Timisoara, Romania
| | - Eugen-Sorin Boia
- Department of Pediatric Surgery and Orthopedics, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
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11
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Acute Kidney Injury in Very Low Birth Weight Infants: A Major Morbidity and Mortality Risk Factor. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020242. [PMID: 36832371 PMCID: PMC9955621 DOI: 10.3390/children10020242] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/13/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Very low birth weight (VLBW) infants are at high risk of developing acute kidney injury (AKI), presumably secondary to low kidney reserves, stressful postnatal events, and drug exposures. Our study aimed to identify the prevalence, risk factors, and outcomes associated with AKI in VLBW infants. STUDY DESIGN Records of all VLBW infants admitted to two medical campuses between January 2019 and June 2020 were retrospectively reviewed. AKI was classified using the modified KDIGO definition to include only serum creatinine. Risk factors and composite outcomes were compared between infants with and without AKI. We evaluated the main predictors of AKI and death with forward stepwise regression analysis. RESULTS 152 VLBW infants were enrolled. 21% of them developed AKI. Based on the multivariable analysis, the most significant predictors of AKI were the use of vasopressors, patent ductus arteriosus, and bloodstream infection. AKI had a strong and independent association with neonatal mortality. CONCLUSIONS AKI is common in VLBW infants and is a significant risk factor for mortality. Efforts to prevent AKI are necessary to prevent its harmful effects.
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12
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Xie J, Ma X, Zheng Y, Mao N, Ren S, Fan J. Panax notoginseng saponins alleviate damage to the intestinal barrier and regulate levels of intestinal microbes in a rat model of chronic kidney disease. Ren Fail 2022; 44:1948-1960. [PMID: 36354128 PMCID: PMC9662016 DOI: 10.1080/0886022x.2022.2143378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives Chronic kidney disease (CKD) is a long-term condition characterized by poor prognosis and a high mortality rate. Panax notoginseng saponins (PNS) are the main active ingredient of the traditional Chinese herb Panaxnotoginseng(Burk.)F.H.Chen, which has been widely reported to have various pharmacological effects. Here, we examined the effect of PNS on renal function and the modulation of intestinal flora and intestinal barrier in a rat model of adenine-induced CKD. Methods Adenine was used to establish a rat model of CKD, biochemical testing, histopathologic examination, ELISA, immunohistochemical assay, western blot assay, and fecal microbiota 16s rRNA analysis was used to test the effect of PNS on CKD rats. Results Adenine induced a significant decrease in glomerular filtration rate, an increase in urinary protein excretion rate, and pathological damage to renal tissue in CKD rats. TNF-α, MCP-1, IL-1β, IL-18, TMAO, and endotoxin levels were increased in the blood of the model rats. Application of PNS countered the effects of adenine, restoring the above parameters to the level observed in healthy rats. In addition, activation of the inflammatory proteins NF-κB (p65) and NLRP3 and the fibrosis-associated proteins α-SMA and smad3 were inhibited in the kidneys of CKD rats. Furthermore, PNS promoted the expression of the tight junction proteins Occludin and ZO-1, increased SIgA levels, strengthened intestinal immunity, reduced mechanical damage to the intestine, was reduced levels of DAO and D-LA. Our data suggest PNS may delay CKD by restoring gut microbiota, and through the subsequent generation of a microbial barrier and modulation of microbiota metabolites. Conclusions In conclusion, PNS may inhibit the development of inflammation and fibrosis in the kidney tissue through regulation of intestinal microorganisms and inhibition of the activation of pro-inflammatory and pro-fibrotic proteins in the kidney.
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Affiliation(s)
- Jing Xie
- Clinical Medical College of Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
- Department of Nephrology No.1, the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Xin Ma
- Department of Nephrology, the First Affiliated Hospital of Chengdu Medical College, Chengdu, PR China
| | - Yixuan Zheng
- Clinical Medical College of Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
- Department of Nephrology No.1, the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Nan Mao
- Department of Nephrology, the First Affiliated Hospital of Chengdu Medical College, Chengdu, PR China
| | - Sichong Ren
- Department of Nephrology, the First Affiliated Hospital of Chengdu Medical College, Chengdu, PR China
- Clinical Medical College of Chengdu Medical College, Chengdu, PR China
| | - Junming Fan
- Department of Nephrology, the First Affiliated Hospital of Chengdu Medical College, Chengdu, PR China
- Clinical Medical College of Chengdu Medical College, Chengdu, PR China
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13
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Aziz KB, Schles EM, Makker K, Wynn JL. Frequency of Acute Kidney Injury and Association With Mortality Among Extremely Preterm Infants. JAMA Netw Open 2022; 5:e2246327. [PMID: 36512358 PMCID: PMC9856227 DOI: 10.1001/jamanetworkopen.2022.46327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Neonatal acute kidney injury (AKI) is common and associated with morbidity and mortality. The temporal relationship between AKI and critical illness, as well as the frequency of AKI definition components (urine output and serum creatinine [sCr] concentration change), are unknown in extremely low-birth-weight (ELBW) (<1000 g), extremely preterm (<29 weeks' completed gestational age [GA]) infants. OBJECTIVE To measure the frequency of AKI from birth to death or discharge with attention to the definition components as well as the temporal relationship of AKI to critical illness and death. DESIGN, SETTING, AND PARTICIPANTS A single-center, multiyear, retrospective cohort study was conducted at an academic level IV neonatal intensive care unit between January 1, 2012, and January 1, 2020. Participants included inborn ELBW and infants at 22 to 28 weeks' completed GA with confirmed congenital anomalies who survived 12 hours or more. EXPOSURES Extremely preterm birth and ELBW. MAIN OUTCOMES AND MEASURES The primary outcome was AKI frequency. The timing, severity, and criteria for AKI were measured. The temporal relationship between AKI, organ dysfunction, and outcomes were quantified using odds ratios (ORs), logistic regression, and Shapley Additive Explanations. Acute kidney injury recognition, imaging, pediatric nephrology consultation, and follow-up were determined. RESULTS A total of 436 infants (52% male; 44% Black) met the inclusion criteria (median BW, 725 g; median GA, 25.7 wk). Acute kidney injury was common in the first week of life (44%), primarily based on the change in the sCr concentration criterion (88%), and negatively associated with GA (OR, 0.69; 95% CI, 0.60-0.78), but positively associated with antecedent critical illness (OR, 1.17; 95% CI, 1.12-1.23), severe intraventricular hemorrhage (OR, 1.86; 95% CI, 1.12-3.08), late-onset sepsis (OR, 1.03; 95% CI, 1.02-1.03), and mortality (OR, 2.77; 95% CI, 1.63-4.72). Acute kidney injury had negligible clinical contribution to death within the model (Shapley Additive Explanation, <0.5% change to outcome) relative to antecedent patient-concentration organ dysfunction (6%-15% change). Among infants with severe AKI, recognition (32%), nephrology inpatient consultation (16%), and outpatient follow-up (9%) were not common. CONCLUSIONS AND RELEVANCE In this cohort study of ELBW infants, AKI was common in the first week of life, inversely associated with GA, and followed organ (primarily cardiovascular) dysfunction. Acute kidney injury considered as the primary pathway to mortality was rare, and amelioration of AKI to modify death was not well supported.
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Affiliation(s)
- Khyzer B. Aziz
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | - Eric M. Schles
- Johns Hopkins Technology and Innovation Center, Johns Hopkins University, Baltimore, Maryland
| | - Kartikeya Makker
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | - James L. Wynn
- Department of Pediatrics, University of Florida, Gainesville
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville
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14
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Thanh NT, Dat NT, Thinh TN, Phuong NTM, Thanh MTH, Bao NT, Son PT, Viet DC, Tung TH, Thien V, Luan VT. Therapeutic plasma exchange and continuous renal replacement therapy in pediatric dengue-associated acute liver failure: A case series from Vietnam. Transfus Apher Sci 2022; 62:103617. [PMID: 36522271 DOI: 10.1016/j.transci.2022.103617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/04/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Paediatric dengue-associated acute liver failure (PALF) is a rare and fatal complication. To date, clinical data regarding the combination of therapeutic plasma exchange (TPE) and continuous renal replacement therapy (CRRT) for the treatment of dengue-associated PALF are limited. METHODS We conducted a single-center, retrospective study of all children with dengue-associated PALF admitted to the paediatric intensive care unit of Children Hospital No.2, Vietnam, who were treated with TPE+CRRT between January 2021 and March 2022. The main study outcomes were in-hospital survival, normalisation of hepatic function, and hepatic encephalopathy improvement. RESULTS Twelve patients aged from 06 to 12 years underwent TPE+CRRT procedures. Among them, three (25 %) patients died of severe sepsis and septic shock confirmed by Enterobacteriaceae spp. haemocultures (stable on maintenance treatment of COVID-19-associated MIS-C with low dose of oral steroids on hospital admission), acute respiratory distress syndrome (ARDS), and clinically apparent intracranial haemorrhage. Nine patients (75 %) survived. The paediatric mortality risk score improved significantly at discharge compared with PICU admission (P < 0.01). Markedly, all twelve patients were diagnosed with hepatoencephalopathy of grades III and IV on PICU admission. After the combined TPE+CRRT interventions, there were substantial improvements in liver transaminases levels, coagulation profiles, and metabolic biomarkers. Normal neurological functions were observed in nine alive patients at hospital discharge. Only one patient experienced an adverse event of slightly low blood pressure, which rapidly self-resolved. INTERPRETATION AND CONCLUSIONS Combined TPE+CRRT significantly improved survival outcome, neurological status, and rapid normalisation of liver functions in dengue-associated PALF.
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Affiliation(s)
- Nguyen Tat Thanh
- Children Hospital 2, Ho Chi Minh City, Viet Nam; Woolcock Institute of Medical Research, Viet Nam
| | - Nguyen Tat Dat
- University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam
| | | | - Ngo Thi Mai Phuong
- Children Hospital 2, Ho Chi Minh City, Viet Nam; University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam.
| | | | | | | | - Do Chau Viet
- Children Hospital 2, Ho Chi Minh City, Viet Nam.
| | | | - Vu Thien
- Shiga University of Medical Science, Otsu City, Shiga, Japan.
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15
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Ong LT. Management and outcomes of acute post-streptococcal glomerulonephritis in children. World J Nephrol 2022; 11:139-145. [PMID: 36187464 PMCID: PMC9521512 DOI: 10.5527/wjn.v11.i5.139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/23/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
Acute post-streptococcal glomerulonephritis (APSGN) is the major cause of acute glomerulonephritis among children, especially in low- and middle-income countries. APSGN commonly occurs following pharyngitis due to the activation of antibodies and complements proteins against streptococcal antigens through the immune-complex-mediated mechanism. APSGN can be presented as acute nephritic syndrome, nephrotic syndrome, and rapidly progressive glomerulonephritis, or it may be subclinical. The management of APSGN is mainly supportive in nature with fluid restriction, anti-hypertensives, diuretics, and renal replacement therapy with dialysis, when necessary, as the disease is self-limiting. Congestive heart failure, pulmonary edema, and severe hypertension-induced encephalopathy might occur during the acute phase of APSGN due to hypervolemia. APSGN generally has a favorable prognosis with only a small percentage of patients with persistent urinary abnormalities, persistent hypertension, and chronic kidney disease after the acute episode of APSGN. Decreased complement levels, increased C-reactive protein, and hypoalbuminemia are associated with disease severity. Crescent formations on renal biopsy and renal insufficiency on presentation may be the predictors of disease severity and poor outcomes in APSGN in children.
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Affiliation(s)
- Leong Tung Ong
- Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
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16
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Massa-Buck B, Rastogi S. Recent Advances in Acute Kidney Injury in Preterm Infants. CURRENT PEDIATRICS REPORTS 2022. [DOI: 10.1007/s40124-022-00271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Rodríguez-Durán A, Martínez-Urbano J, Laguna-Castro M, Crespo-Montero R. Lesión renal aguda en el paciente pediátrico: revisión integrativa. ENFERMERÍA NEFROLÓGICA 2022. [DOI: 10.37551/s2254-28842022002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Introducción: La lesión renal aguda se ha convertido en una complicación común en los niños hospitalizados, especialmente cuando están en una situación clínica crítica. Objetivo: Conocer y sintetizar la bibliografía científica más actualizada sobre la lesión renal aguda en la población pediátrica. Metodología: Estudio descriptivo de revisión integrativa. La búsqueda de artículos se ha realizado en las bases de datos Pubmed, Scopus y Google Scholar. La estrategia de búsqueda se estableció con los siguientes términos MeSH: ”acute kidney injury”, “children” y “pediatric”. La calidad metodológica se realizó mediante la escala STROBE. Resultados: Se incluyeron 35 artículos, 19 de diseño observacional retrospectivo, 12 observacionales prospectivos, 3 revisiones bibliográficas y 1 estudio cualitativo. No hay variables sociodemográficas destacables que impliquen mayor probabilidad de presentar lesión renal aguda. Tanto la etiología como los factores de riesgo son muy variables. La lesión renal aguda se asocia a mayor número de complicaciones y estancia hospitalaria. No hay evidencia de cuidados enfermeros en la lesión renal aguda en pacientes pediátricos. Conclusiones: Se observa una falta de homogeneidad en los criterios de definición, incidencia, etiología, factores de riesgo y de tratamiento en los pacientes pediátricos con lesión renal aguda, y escasez de artículos originales de investigación. La lesión renal aguda pediátrica se asocia a mayor mortalidad, morbilidad, mayor estancia hospitalaria y mayor duración de la ventilación mecánica. El papel de enfermería en el manejo del tratamiento conservador y de las terapias de reemplazo renal de este cuadro, es fundamental en la supervivencia de estos pacientes.
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Affiliation(s)
- Ana Rodríguez-Durán
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. España
| | - Julia Martínez-Urbano
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. España
| | - Marta Laguna-Castro
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. España
| | - Rodolfo Crespo-Montero
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. Servicio de Nefrología. Hospital Universitario Reina Sofía de Córdoba. Instituto Maimónides de Investigación Biomédica de Córdoba. España
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18
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Raina R, Sethi SK, Chakraborty R, Singh S, Teo S, Khooblall A, Montini G, Bunchman T, Topaloglu R, Yap HK. Blood Filters in Children with COVID-19 and AKI: A Review. Ther Apher Dial 2022; 26:566-582. [PMID: 34997670 DOI: 10.1111/1744-9987.13793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/11/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022]
Abstract
COVID-19 has challenged the global healthcare system through rapid proliferation and lack of existing treatment resulting in over 180 million cases and 3.8 million deaths since December 2019. Although pediatric patients only comprise 1-2% of diagnosed cases, their incidence of acute kidney injury ranges from 8.2% to 18.2% compared to 49% in adults. Severe infection, initiated by dysregulated host response, can lead to multiorgan failure. In this review, we focus on the use of various blood filters approved for use in pediatric kidney replacement therapy to mitigate adverse effects of severe illness. Therapeutic effects of these blood filters range from cytokine removal (CytoSorb, HA330, HCO/MCO), endotoxin removal (Toraymyxin, CPFA), both cytokine and endotoxin removal (oXiris), and non-specific removal of proteins (PMMA) that have already been established and can be used to mitigate the various effects of the cytokine storm syndrome in COVID-19.
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Affiliation(s)
- Rupesh Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH.,Department of Nephrology, Akron Children's Hospital, Akron, OH
| | - Sidharth Kumar Sethi
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India
| | - Ronith Chakraborty
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH.,Department of Nephrology, Akron Children's Hospital, Akron, OH
| | - Siddhartha Singh
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH.,Department of Nephrology, Akron Children's Hospital, Akron, OH
| | - Sharon Teo
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Amrit Khooblall
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH.,Department of Nephrology, Akron Children's Hospital, Akron, OH
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Ca' Granda IRCCS, Policlinico di Milano, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Timothy Bunchman
- Pediatric Nephrology & Transplantation, Children's Hospital of Richmond at VCU, Richmond, VA
| | - Rezan Topaloglu
- Department of Pediatric Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hui Kim Yap
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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19
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Eminoğlu FT, Öncül Ü, Kahveci F, Okulu E, Kraja E, Köse E, Kendirli T. Characteristics of continuous venovenous hemodiafiltration in the acute treatment of inherited metabolic disorders. Pediatr Nephrol 2022; 37:1387-1397. [PMID: 34693482 PMCID: PMC8542505 DOI: 10.1007/s00467-021-05329-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Continuous kidney replacement therapies (CKRT) have been reported to be an effective approach to removing toxic metabolites in inborn errors of metabolism (IEM). The present study evaluates efficiency and complications of CKRT in children with IEM. METHODS Patients diagnosed with IEM who underwent CKRT in pediatric and neonatal intensive care units were analyzed. CKRT were initiated in patients with persistently high blood ammonia levels (≥ 500 μmol/L), blood ammonia levels > 250 μmol/L in the presence of moderate encephalopathy, high blood leucine levels (≥ 1500 μmol/L), and blood leucine levels < 1500 μmol/L in the presence of deteriorating neurological status or persistent metabolic acidosis. RESULTS Of 22 patients enrolled, nine (40.9%) Maple syrup urine disease (MSUD), eight (36.4%) urea cycle disorders (UCD), and five (22.7%) organic acidemias (OA). Median age was 72.3 [9.9-1040.8] days. In total, 28 dialysis sessions were analyzed [16 (57.1%) continuous venovenous hemodialysis, and 12 (42.9%) continuous venovenous hemodiafiltration]. A significant decrease was noted in leucine levels (from 1608.4 ± 885.3 to 314.6 ± 109.9 µmol/L) of patients with MSUD, while ammonia levels were significantly decreased in patients with UCD and OA (from 1279.9 ± 612.1 to 85.1 ± 21.6 µmol/L). The most frequent complications of CKRT were thrombocytopenia (60.7%), hypotension (53.6%), and hypocalcemia (42.9%). Median age of patients with hypotension treated with vasoactive medications was significantly lower than median age of those with normal blood pressure. CONCLUSION CKRT is a reliable approach for effective and rapid removal of toxic metabolites in children with IEM, and CKRT modalities can be safely used and are well-tolerated in infants.
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Affiliation(s)
- Fatma Tuba Eminoğlu
- Department of Pediatric Metabolism, Faculty of Medicine, Ankara University, Ankara, Turkey.
| | - Ümmühan Öncül
- Department of Pediatric Metabolism, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Fevzi Kahveci
- Department of Pediatric Intensive Care Unit, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Emel Okulu
- Department of Neonatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Elvis Kraja
- Department of Neonatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Engin Köse
- Department of Pediatric Metabolism, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care Unit, Faculty of Medicine, Ankara University, Ankara, Turkey
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20
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Guzzo I, de Galasso L, Bayazit AK, Yildizdas D, Schmitt CP, Hayes W, Shroff R, Jankauskiene A, Virsilas E, Longo G, Vidal E, Mir S, Bulut IK, Tkaczyk M, Mencarelli F, Bertulli C, Cvetkovic M, Kostic M, Paglialonga F, Montini G, Yilmaz E, Teixeira A, Atmis B, Schaefer F. Acute pediatric kidney replacement therapies in Europe: demographic results from the EurAKId Registry. Nephrol Dial Transplant 2021; 37:770-780. [PMID: 34586417 DOI: 10.1093/ndt/gfab280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI), particularly that requiring dialysis, is a severe complication in hospitalized children associated with high morbidity and mortality. A prospective European AKI registry (EurAKId registry, NCT02960867) was created to describe the epidemiology and outcomes of pediatric patients treated with acute dialysis. METHODS Children were recruited who were between 0 and 18 years of age and were treated both in and outside the Pediatric Intensive Care Unit (PICU) with peritoneal dialysis (PD), hemodialysis (HD) or continuous kidney replacement therapy (CKRT) for AKI or metabolic derangement, fluid overload (FO), sepsis, or respiratory distress. Five age groups and 12 categories of primary diseases were defined. RESULTS Data on 340 patients were analyzed, of whom 86% received dialysis for AKI and 14% for reasons other than AKI. Boys accounted for 60% of the patients. Illness severity was greater in children with cardiac and hematologic diseases than those with kidney diseases. Most patients received dialysis in the PICU (84%). The most frequently used dialysis modality was CKRT (64%), followed by PD (14%) and HD (14%). The overall survival rate was 65%. Survival was significantly lower in children with three comorbidities than in children with no comorbidities (41% and 83%, p < 0.001). CONCLUSIONS The EurAKId registry is the first prospective registry considering pediatric acute kidney replacement therapies (KRT) in both critical and non-critical care settings, focusing on the three dialysis modalities in Europe. The clinical indications for KRT have expanded; our population was characterized by critically ill patients, primarily boys, who frequently received dialysis in the PICU with CKRT.
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Affiliation(s)
- Isabella Guzzo
- Division of Nephrology and Dialysis, Department of Pediatrics, Bambino Gesù Children's Hospital and Research Institute, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Lara de Galasso
- Division of Nephrology and Dialysis, Department of Pediatrics, Bambino Gesù Children's Hospital and Research Institute, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Aysun Karabay Bayazit
- Department of Pediatric Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Dincer Yildizdas
- Department of Pediatric Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Claus Peter Schmitt
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Wesley Hayes
- Department of Pediatric Nephrology, UCL Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rukshana Shroff
- Department of Pediatric Nephrology, UCL Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Augustina Jankauskiene
- Clinic of Pediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Ernestas Virsilas
- Clinic of Pediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Germana Longo
- Pediatric Nephrology, Azienda Ospedaliera-University of Padua, Padua, Italy
| | - Enrico Vidal
- Pediatric Nephrology, Azienda Ospedaliera-University of Padua, Padua, Italy
| | - Sevgi Mir
- Department of Pediatric Nephrology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ipek Kaplan Bulut
- Department of Pediatric Nephrology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Marcin Tkaczyk
- Department of Pediatrics and Immunology, Nephrology Division, Polish Mothers Memorial Hospital Research Institute, Lodz, Poland
| | - Francesca Mencarelli
- Nephrology and Dialysis Unit, Department of Pediatrics, S Orsola-Malpighi Hospital, Scientific Institute for Research and Healthcare (IRCCS), Bologna, Italy
| | - Cristina Bertulli
- Nephrology and Dialysis Unit, Department of Pediatrics, S Orsola-Malpighi Hospital, Scientific Institute for Research and Healthcare (IRCCS), Bologna, Italy
| | - Mrjana Cvetkovic
- Department of Nephrology, University Children Hospital, Belgrade, Serbia
| | - Mirjana Kostic
- Department of Nephrology, University Children Hospital, Belgrade, Serbia
| | - Fabio Paglialonga
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Ca' Grande IRRCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Ca' Grande IRRCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Ebru Yilmaz
- Pediatric Nephrology, Dr Behcet Children Research and Education Hospital, Izmir, Turkey
| | - Ana Teixeira
- Pediatric Nephrology, Centro Materno-Infantil do Norte, Porto, Portugal
| | - Bahriye Atmis
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
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21
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Pharmacokinetics of Antibiotics in Pediatric Intensive Care: Fostering Variability to Attain Precision Medicine. Antibiotics (Basel) 2021; 10:antibiotics10101182. [PMID: 34680763 PMCID: PMC8532953 DOI: 10.3390/antibiotics10101182] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/16/2022] Open
Abstract
Children show important developmental and maturational changes, which may contribute greatly to pharmacokinetic (PK) variability observed in pediatric patients. These PK alterations are further enhanced by disease-related, non-maturational factors. Specific to the intensive care setting, such factors include critical illness, inflammatory status, augmented renal clearance (ARC), as well as therapeutic interventions (e.g., extracorporeal organ support systems or whole-body hypothermia [WBH]). This narrative review illustrates the relevance of both maturational and non-maturational changes in absorption, distribution, metabolism, and excretion (ADME) applied to antibiotics. It hereby provides a focused assessment of the available literature on the impact of critical illness—in general, and in specific subpopulations (ARC, extracorporeal organ support systems, WBH)—on PK and potential underexposure in children and neonates. Overall, literature discussing antibiotic PK alterations in pediatric intensive care is scarce. Most studies describe antibiotics commonly monitored in clinical practice such as vancomycin and aminoglycosides. Because of the large PK variability, therapeutic drug monitoring, further extended to other antibiotics, and integration of model-informed precision dosing in clinical practice are suggested to optimise antibiotic dose and exposure in each newborn, infant, or child during intensive care.
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22
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Wang Y, Gu Z. Effect of bioimpedance-defined overhydration parameters on mortality and cardiovascular events in patients undergoing dialysis: a systematic review and meta-analysis. J Int Med Res 2021; 49:3000605211031063. [PMID: 34496645 PMCID: PMC8438275 DOI: 10.1177/03000605211031063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/18/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the role of bioimpedance-defined overhydration (BI-OH) parameters in predicting the risk of mortality and cardiovascular (CV) events in patients undergoing dialysis. METHODS We searched multiple electronic databases for studies investigating BI-OH indicators in the prediction of mortality and CV events through 23 May 2020. We assessed the effect of BI-OH indexes using unadjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Sensitivity analysis was used for each outcome. RESULTS We included 55 studies with 104,758 patients in the meta-analysis. Extracellular water/total body water (ECW/TBW) >0.4 (HR 5.912, 95% CI: 2.016-17.342), ECW/intracellular water (ICW) for every 0.01 increase (HR 1.041, 95% CI: 1.031-1.051), and OH/ECW >15% (HR 2.722, 95% CI: 2.005-3.439) increased the risk of mortality in patients receiving dialysis. ECW/TBW >0.4 (HR 2.679, 95% CI: 1.345-5.339) and ECW/ICW per increment of 10% (HR 1.032, 95% CI: 1.017-1.047) were associated with an increased risk of CV events in patients undergoing dialysis. A 1-degree increase in phase angle was a protective factor for both mortality (HR 0.676, 95% CI: 0.474-0.879) and CV events (HR 0.736, 95% CI: 0.589-0.920). CONCLUSIONS BI-OH parameters might be independent predictors for mortality and CV events in patients undergoing dialysis.
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Affiliation(s)
- Yajie Wang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zejuan Gu
- Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
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23
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Askenazi D, Basu RK. Kidney support therapy in the pediatric patient: Unique considerations for a unique population. Semin Dial 2021; 34:530-536. [PMID: 33909936 DOI: 10.1111/sdi.12978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
The use of kidney support therapy (KST) for use in managing patients with acute kidney injury (AKI) has expanded greatly in the last several decades. The growing use of KST modalities in children, and now in neonates, has been associated with opportunities for education, clinical research, clinical practice improvements, and outcomes research. A multitude of controversies exist in the field of pediatric KST-many of which are shared by adult critical care nephrology practice. Simultaneously, pediatric KST has led the way to a burgeoning exploration of the importance of fluid overload as it relates to KST initiation and management and also with quality improvement. In this review, we will explore and describe the paradigms contained with pediatric KST used to support children with AKI. In addition to the governing principles related to the mechanics of KST, we will describe the novel aspects of newer support machines and ethical considerations of KST provision. Anticoagulation, dose, and modality will be discussed as well as priming procedures for special considerations. The utilization of KST across pediatric populations represents the next frontier of critical care nephrology.
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Affiliation(s)
- David Askenazi
- Pediatric and Infant Center for Acute Nephrology Children's of Alabama, Division of Pediatric Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rajit K Basu
- Division of Critical Care, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University, Atlanta, GA, USA
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24
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Raina R, McCulloch M, Nourse P, Sethi SK, Yap HK. Advances in Kidney Replacement Therapy in Infants. Adv Chronic Kidney Dis 2021; 28:91-104. [PMID: 34389141 DOI: 10.1053/j.ackd.2021.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/30/2022]
Abstract
Acute kidney injury continues to be a highly occurring disease in the intensive care unit, specifically affecting up to a third of critically ill neonates as per various studies. Although first-line treatments of acute kidney injury are noninvasive, kidney replacement therapy (KRT) is indicated when conservative management modes fail. There are various modalities of KRT which can be used for neonatal populations, including peritoneal dialysis, hemodialysis, and continuous KRT. However, these KRT modalities present their own challenges in this specific patient population Thus, it is the aim of this review to introduce each of these KRT modalities in terms of their challenges, advances, and future directions, with specific emphasis on new technology including the Cardio-Renal Pediatric Emergency Dialysis Machine, Newcastle infant dialysis and ultrafiltration system, and the Aquadex system for ultrafiltration.
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