Research Article
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Continuous Renal Replacement Therapy in Critically Pediatric Patients

Year 2022, Volume: 22 Issue: 1, 38 - 41, 18.05.2022
https://doi.org/10.26650/jchild.2022.1017478

Abstract

Objective: Continuous renal replacement therapy (CRRT) in pediatric intensive care units is frequently used for the treatment of severe acute kidney injury and/or fluid balance, acid-base and metabolic disorders. There are various techniques and difficulties and complications in the application of this treatment, from the choice of catheter to the anticoagulation used. In this study, we reported CRRT indications, complications, and our experience with two different anticoagulants. Materials and Methods: In this study, the data of patients who had undergone Continuous Renal Replacement Therapy in the pediatric intensive care unit (PICU) of a tertiary university hospital between October 2020 and September 2021 was studied Results: The median age of the patients was 120 months (2-204) and 16 (47.1%) were girls. Regional citrate anticoagulation was used as the anticoagulant in 22 (64.7%) patients and heparin was used in 12 (35.3%) patients who had undergone continuous renal replacement therapy. Indications for CRRT were, respectively, acute renal failure (32.4%, n=11), fluid overload (26.5%, n=9), metabolic acidosis-electrolyte disorder (20.6% n=7), tumor lysis syndrome (14.7%, n=5), hyperammonemia (2.9%, n=1), and intoxication (2.9%, n=1). In the citrate group, the mean cycle time was found to be 50.1±22 hours, regardless of the hemofilter type, while it was 28.5±16.6 hours in the heparin group. The mean cycle life was found to be significantly higher in the citrate group (p=0.01). The increase in calcium value was found to be significantly higher in the citrate group (p=0.005) Conclusion: We think that the use of regional citrate anticoagulation prolongs the life of the hemofilter and may be important because it can reduce the occurrence of both complications and side effects when these critically ill patients need CRRT for a long time.

References

  • 1. Westrope CA, Fleming S, Kapetanstrataki M, Parslow RC, Morris KP. Renal replacement therapy in the critically ill child. Pediatric Critical Care Medicine 2018;19(3):210-217. google scholar
  • 2. Sanderson KR, Harshman LA. Renal replacement therapies for infants and children in the ICU. Current Opinion in Pediatrics 2020;32(3):360. google scholar
  • 3. Tuncer GHE, Ekim M, Okulu E, Atasay B, Kendirli T. Continuous renal replacement therapy in critically ill children: single-center experience. Turkish Journal of Medical Sciences 2021;51(1):188-194. google scholar
  • 4. Sık G, Demirbuga A, Annayev A, Citak A. Regional citrate versus systemic heparin anticoagulation for continuous renal replacement therapy in critically ill children. The International Journal of Artificial Organs 2020;43(4):234-241. google scholar
  • 5. Beltramo F, DiCarlo J, Gruber JB, Taylor T, Totapally BR. Renal replacement therapy modalities in critically ill children. Pediatric Critical Care Medicine 2019;20(1);e1- e9. google scholar
  • 6. Symons JM, Chua AN, Somers MJ, Baum MA, Bunchman TE, Benfield MR, et al. Demographic characteristics of pediatric continuous renal replacement therapy: a report of the prospective pediatric continuous renal replacement therapy registry. Clinical Journal of the American Society of Nephrology 2007;2(4):732-738. google scholar
  • 7. Goldstein SL, Somers MJG, Brophy PD, Bunchman TE, Baum M, Blowey D, et al. The prospective pediatric continuous renal replacement therapy (ppCRRT) registry: design, development and data assessed. The International Journal of Artificial Organs 2004;27(1):9-14. google scholar
  • 8. Goldstein SL, Currier H, Graf JM, Cosio CC, Brewer ED, Sachdeva R. Outcome in children receiving continuous venovenous hemofiltration. Pediatrics 2001;107(6):1309-1312. google scholar
  • 9. Brophy PD, Somers MJ, Baum MA, Symons JM, McAfee N, Fortenberry JD, et al. Multi-centre evaluation of anticoagulation in patients receiving continuous renal replacement therapy (CRRT). Nephrology Dialysis Transplantation 2005;20(7):1416-1421. google scholar
  • 10. Rico MP, Fernandez Sarmiento J, Rojas Velasquez AM, Gonzalez Chaparro LS, Gastelbondo Amaya R, Mulett H, et al. Regional citrate anticoagulation for continuous renal replacement therapy in children. Pediatric Nephrology 2017;32(4):703-711. google scholar
  • 11. Raymakers-Janssen PA, Lilien M, van Kessel IA, Veldhoen ES, Wösten-van Asperen RM, van Gestel JP. Citrate versus heparin anticoagulation in continuous renal replacement therapy in small children. Pediatric Nephrology 2017;32(10):1971-1978. google scholar
  • 12. Bai M, Zhou M, He L, Ma F, Li Y, Yu Y, et al. Citrate versus heparin anticoagulation for continuous renal replacement therapy: an updated meta-analysis of RCTs. Intensive Care Medicine 2015;41(12):2098-2110. google scholar
  • 13. Mehta RL, Mcdonald BR, Aguilar MM, Ward DM. Regional citrate anticoagulation for continuous arteriovenous hemodialysis in critically ill patients. Kidney International 1990;38(5):976-981. google scholar
  • 14. Gao J, Wang F, Wang Y, Jin D, Tang L, Pan K. A mode of CVVH with regional citrate anticoagulation compared to no anticoagulation for acute kidney injury patients at high risk of bleeding. Scientific Reports 2019;9(1):1-10. google scholar
  • 15. Elhanan N, Skippen P, Nuthall G, Krahn G, Seear M. Citrate anticoagulation in pediatric continuous venovenous hemofiltration.Pediatric Nephrology2004;19(2):208- 212. google scholar
  • 16. Chadha V, Garg U, Warady BA, Alon US. Citrate clearance in children receiving continuous venovenous renal replacement therapy. Pediatric Nephrology 2002;17(10):819-824. google scholar

Kritik Çocuk Hastalarda Sürekli Renal Replasman Tedavisi

Year 2022, Volume: 22 Issue: 1, 38 - 41, 18.05.2022
https://doi.org/10.26650/jchild.2022.1017478

Abstract

Amaç: Çocuk yoğun bakım ünitelerinde sürekli renal replasman tedavisi (SRRT), şiddetli akut böbrek hasarının tedavisi ve/veya sıvı dengesi, asitbaz ve metabolik düzensizlikte sıklıkla kullanılmaktadır. Bu tedavinin uygulamasında; kateter seçiminden, kullanılan antikoagülasyon yöntemine kadar çeşitli teknik zorluklarla karşılaşılmakta ve komplikasyonlar görülebilmektedir. Bu çalışmayı yapmaktaki amacımız, SRRT endikasyonları ve komplikasyonlarını değerlendirmek, kullanılan iki farklı antikoagülasyon yöntemini karşılaştırarak deneyimlerimizi paylaşmaktır. Gereç ve Yöntem: Bu çalışmada, bir üniversite hastanesinin 3.basamak çocuk yoğun bakım ünitesinde (ÇYBÜ) Ekim 2020 ile Eylül 2021 tarihleri arasında Sürekli Renal Replasman Tedavisi uygulanan hastaların verileri geriye dönük olarak değerlendirildi. Bulgular: Hastaların ortanca yaşı 120 ay (2-204) ve 16’sı kızdı (%47,1). Sürekli renal replasman tedavisi uygulanan 22 (%64,7) hastada bölgesel sitrat antikoagülasyonu, 12 (%35,3) hastada ise heparin antikoagülan kullanıldı. SRRT endikasyonları sırasıyla, akut böbrek yetmezliği (11, %32,4), sıvı yüklenmesi (9, %26,5), metabolik asidoz /elektrolit bozukluğu (7, %20,6), tümör yıkım sendromu (5, %14,7), hiperamonyemi (1, %2,9), intoksikasyon (1, %2.9) idi. Sitrat kullanılan grupta filtre tipinden bağımsız devre ömrü ortalama 50,1±22 saat iken heparin grubunda bu süre ortalama 28,5±16,6 saat olarak bulundu (p=0,01). Serum kalsiyum düzeyi sitrat grubunda heparin grubuna göre anlamlı olarak daha yüksek tespit edildi (p=0,005). Sonuç: Bölgesel sitrat antikoagülasyon kullanımı filtre ömrünü uzatmaktadır. Bu durumun karşılaşılabilecek teknik problemleri ve iş yükünü azalttığını, maliyete belirgin katkı sağladığını düşünmekteyiz.

References

  • 1. Westrope CA, Fleming S, Kapetanstrataki M, Parslow RC, Morris KP. Renal replacement therapy in the critically ill child. Pediatric Critical Care Medicine 2018;19(3):210-217. google scholar
  • 2. Sanderson KR, Harshman LA. Renal replacement therapies for infants and children in the ICU. Current Opinion in Pediatrics 2020;32(3):360. google scholar
  • 3. Tuncer GHE, Ekim M, Okulu E, Atasay B, Kendirli T. Continuous renal replacement therapy in critically ill children: single-center experience. Turkish Journal of Medical Sciences 2021;51(1):188-194. google scholar
  • 4. Sık G, Demirbuga A, Annayev A, Citak A. Regional citrate versus systemic heparin anticoagulation for continuous renal replacement therapy in critically ill children. The International Journal of Artificial Organs 2020;43(4):234-241. google scholar
  • 5. Beltramo F, DiCarlo J, Gruber JB, Taylor T, Totapally BR. Renal replacement therapy modalities in critically ill children. Pediatric Critical Care Medicine 2019;20(1);e1- e9. google scholar
  • 6. Symons JM, Chua AN, Somers MJ, Baum MA, Bunchman TE, Benfield MR, et al. Demographic characteristics of pediatric continuous renal replacement therapy: a report of the prospective pediatric continuous renal replacement therapy registry. Clinical Journal of the American Society of Nephrology 2007;2(4):732-738. google scholar
  • 7. Goldstein SL, Somers MJG, Brophy PD, Bunchman TE, Baum M, Blowey D, et al. The prospective pediatric continuous renal replacement therapy (ppCRRT) registry: design, development and data assessed. The International Journal of Artificial Organs 2004;27(1):9-14. google scholar
  • 8. Goldstein SL, Currier H, Graf JM, Cosio CC, Brewer ED, Sachdeva R. Outcome in children receiving continuous venovenous hemofiltration. Pediatrics 2001;107(6):1309-1312. google scholar
  • 9. Brophy PD, Somers MJ, Baum MA, Symons JM, McAfee N, Fortenberry JD, et al. Multi-centre evaluation of anticoagulation in patients receiving continuous renal replacement therapy (CRRT). Nephrology Dialysis Transplantation 2005;20(7):1416-1421. google scholar
  • 10. Rico MP, Fernandez Sarmiento J, Rojas Velasquez AM, Gonzalez Chaparro LS, Gastelbondo Amaya R, Mulett H, et al. Regional citrate anticoagulation for continuous renal replacement therapy in children. Pediatric Nephrology 2017;32(4):703-711. google scholar
  • 11. Raymakers-Janssen PA, Lilien M, van Kessel IA, Veldhoen ES, Wösten-van Asperen RM, van Gestel JP. Citrate versus heparin anticoagulation in continuous renal replacement therapy in small children. Pediatric Nephrology 2017;32(10):1971-1978. google scholar
  • 12. Bai M, Zhou M, He L, Ma F, Li Y, Yu Y, et al. Citrate versus heparin anticoagulation for continuous renal replacement therapy: an updated meta-analysis of RCTs. Intensive Care Medicine 2015;41(12):2098-2110. google scholar
  • 13. Mehta RL, Mcdonald BR, Aguilar MM, Ward DM. Regional citrate anticoagulation for continuous arteriovenous hemodialysis in critically ill patients. Kidney International 1990;38(5):976-981. google scholar
  • 14. Gao J, Wang F, Wang Y, Jin D, Tang L, Pan K. A mode of CVVH with regional citrate anticoagulation compared to no anticoagulation for acute kidney injury patients at high risk of bleeding. Scientific Reports 2019;9(1):1-10. google scholar
  • 15. Elhanan N, Skippen P, Nuthall G, Krahn G, Seear M. Citrate anticoagulation in pediatric continuous venovenous hemofiltration.Pediatric Nephrology2004;19(2):208- 212. google scholar
  • 16. Chadha V, Garg U, Warady BA, Alon US. Citrate clearance in children receiving continuous venovenous renal replacement therapy. Pediatric Nephrology 2002;17(10):819-824. google scholar
There are 16 citations in total.

Details

Primary Language Turkish
Subjects Paediatrics
Journal Section Research Articles
Authors

Gürkan Atay 0000-0002-0317-5872

Publication Date May 18, 2022
Published in Issue Year 2022 Volume: 22 Issue: 1

Cite

APA Atay, G. (2022). Kritik Çocuk Hastalarda Sürekli Renal Replasman Tedavisi. Journal of Child, 22(1), 38-41. https://doi.org/10.26650/jchild.2022.1017478
AMA Atay G. Kritik Çocuk Hastalarda Sürekli Renal Replasman Tedavisi. Journal of Child. May 2022;22(1):38-41. doi:10.26650/jchild.2022.1017478
Chicago Atay, Gürkan. “Kritik Çocuk Hastalarda Sürekli Renal Replasman Tedavisi”. Journal of Child 22, no. 1 (May 2022): 38-41. https://doi.org/10.26650/jchild.2022.1017478.
EndNote Atay G (May 1, 2022) Kritik Çocuk Hastalarda Sürekli Renal Replasman Tedavisi. Journal of Child 22 1 38–41.
IEEE G. Atay, “Kritik Çocuk Hastalarda Sürekli Renal Replasman Tedavisi”, Journal of Child, vol. 22, no. 1, pp. 38–41, 2022, doi: 10.26650/jchild.2022.1017478.
ISNAD Atay, Gürkan. “Kritik Çocuk Hastalarda Sürekli Renal Replasman Tedavisi”. Journal of Child 22/1 (May 2022), 38-41. https://doi.org/10.26650/jchild.2022.1017478.
JAMA Atay G. Kritik Çocuk Hastalarda Sürekli Renal Replasman Tedavisi. Journal of Child. 2022;22:38–41.
MLA Atay, Gürkan. “Kritik Çocuk Hastalarda Sürekli Renal Replasman Tedavisi”. Journal of Child, vol. 22, no. 1, 2022, pp. 38-41, doi:10.26650/jchild.2022.1017478.
Vancouver Atay G. Kritik Çocuk Hastalarda Sürekli Renal Replasman Tedavisi. Journal of Child. 2022;22(1):38-41.