Continuous Renal Replacement Therapy in Critically Pediatric Patients

Öz

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.

Anahtar Kelimeler

• Renal Replacement
• pediatric
• citrate

Kritik Çocuk Hastalarda Sürekli Renal Replasman Tedavisi

Öz

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.

Anahtar Kelimeler

• Renal Replasman
• çocuk
• sitrat

Kaynakça

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