Renal Supportive Therapy for Pediatric Acute Kidney Injury in the Setting of Multiorgan Dysfunction Syndrome/Sepsis
Section snippets
Timing of Initiation of RST
Few topics in the pediatric RST realm have been as controversial as delineating the optimal timing of RST initiation. Over the past several years both pediatric and adult data have supported the implementation of RST earlier in the course of care4, 5, 6; such a strategy is particularly relevant in pediatric care because children tend to develop their maximal organ failures and die more rapidly than the adult population.7 Classically defined indicators for RST initiation in the setting of AKI
Modality Choice
A number of modalities are available for RST provision in the pediatric patient with MODS/sepsis-associated AKI. Intermittent hemodialysis (HD), peritoneal dialysis (PD), and CRRTs such as continuous venovenous hemodialysis (CVVHD) (predominantly diffusive clearance), CVVH (convective clearance), or continuous venovenous hemodiafiltration (CVVHDF) (both convective and diffusive clearance), may be used to provide enhanced solute clearance and ultrafiltration.33, 34 In addition to these classic
Conclusions
Significant questions remain with respect to the initiation timing, modality choice duration, and frequency of these therapies in the clinical setting.9 The variables impacting these decisions are numerous and significant. Wider approaches to blood purification in sepsis are promising and these techniques usually are well tolerated and are effective in clearing septic mediators with subsequent improvement in physiologic parameters. Direct demonstration in improvement in mortality rates has been
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Cited by (24)
Acute Kidney Injury in Children. An Update on Diagnosis and Treatment.
2013, Pediatric Clinics of North AmericaCitation Excerpt :Reported mortality in children with AKI receiving continuous renal replacement therapies (CRRTs) has ranged from 32.1% to 58.9% in studies since 2000.29 AKI synergistically increases morbidity and mortality in children with multiple organ failure, hematopoietic stem cell transplantation, trauma, and extracorporeal membrane oxygenation, independent of severity of illness scoring.32–35 Effects of AKI are also long lasting in survivors, with chronic renal insufficiency in almost half of patients at 3-year to 5-year follow-up, suggesting permanent alteration of the renal parenchyma.36
An update and review of acute kidney injury in pediatrics
2011, Pediatric Critical Care MedicineCitation Excerpt :In a study of nearly 4,000 critically ill children, AKI increased mortality and lengthened intensive care stay four-fold (48). AKI increases mortality with multi-organ failure, marrow or solid organ transplantation, extracorporeal membrane oxygenation, or acute respiratory distress syndrome from 10% to 57.1% (12, 50–51). AKI has a high risk of death independent of Pediatric Risk of Mortality II scores in these patients (49).
Fluid balance
2021, The Great Ormond Street Hospital: Manual of Children and Young People’s Nursing Practices: Second EditionUnderstanding the effects of kidney disease and dialysis treatment on pharmacotherapy in children
2020, Handbook of Experimental PharmacologyHealth insurance status and risk factors of mortality in patients with septic acute kidney injury in Ningbo, China
2019, Journal of International Medical ResearchResveratrol ameliorates sepsis-induced acute kidney injury in a pediatric rat model via Nrf2 signaling pathway
2018, Experimental and Therapeutic Medicine