Continuous Renal Replacement Therapy for Children ≤10 kg: A Report from the Prospective Pediatric Continuous Renal Replacement Therapy Registry - 26/02/13
, Stuart L. Goldstein, MD 2, Rajesh Koralkar, MBBS, MPH 1, James Fortenberry, MD 3, Michelle Baum, MD 4, Richard Hackbarth, MD 5, Doug Blowey, MD 6, Timothy E. Bunchman, MD 7, Patrick D. Brophy, MD 8, Jordan Symons, MD 9, Annabelle Chua, MD 10, Francisco Flores, MD 11, Michael J.G. Somers, MD 4
Reprint requests: David J. Askenazi, MD, MSPH, University of Alabama at Birmingham, Department of Pediatrics, Division of Nephrology, 1600 7th Ave South, ACC 516, Birmingham, AL 35233.Abstract |
Objective |
To report circuit characteristics and survival analysis in children weighing ≤10 kg enrolled in the Prospective Pediatric Continuous Renal Replacement Therapy (ppCRRT) Registry.
Study design |
We conducted prospective cohort analysis of the ppCRRT Registry to: (1) evaluate survival differences in children ≤10 kg compared with other children; (2) determine demographic and clinical differences between surviving and non-surviving children ≤10 kg; and (3) describe continuous renal replacement therapy (CRRT) circuit characteristics differences in children ≤5 kg versus 5-10 kg.
Results |
The ppCRRT enrolled 84 children ≤10 kg between January 2001 and August 2005 from 13 US tertiary centers. Children ≤10 kg had lower survival rates than children >10 kg (36/84 [43%] versus 166/260 [64%]; P < .001). In children ≤10 kg, survivors were more likely to have fewer days in intensive care unit prior to CRRT, lower Pediatric Risk of Mortality 2 scores at intensive care unit admission and lower mean airway pressure (Paw), higher urine output, and lower percent fluid overload (FO) at CRRT initiation. Adjusted regression analysis revealed that Pediatric Risk of Mortality 2 scores, FO, and decreased urine output were associated with mortality. Compared with circuits from children 5-10 kg at CRRT initiation, circuits from children ≤5 kg more commonly used blood priming for initiation, heparin anticoagulation, and higher blood flows/effluent flows for body weight.
Conclusion |
Mortality is more common in children who are ≤10 kg at the time of CRRT initiation. Like other CRRT populations, urine output and FO at CRRT initiation are independently associated with mortality. CRRT prescription differs in small children.
Le texte complet de cet article est disponible en PDF.Keyword : AKI, CRRT, %FO, FO, ICU, Paw, ppCRRT, PRISM
Plan
| ppCRRT received unrestricted grant funding from Gambro Renal Products, Dialysis Solutions, Inc, Baxter Healthcare, and B Braun, Inc. D.A. and S.G. serve as a consultant and an expert panelist for Gambro. T.B. and F.F. serve as expert panelists for Gambro. S.G. receives grant support from Gambro and Baxter. D.A. is supported through the Norman Siegel Career Development Award from the American Society of Nephrology and received a pilot and feasibility grant from the National Institutes of Health (sponsored by the O’Brien Center for Acute Kidney Injury Research). The other authors declare no conflicts of interest. |
Vol 162 - N° 3
P. 587 - mars 2013 Retour au numéro
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