Pediatric Continuous Renal Replacement Therapy.

BACKGROUND

Continuous renal replacement therapy (CRRT) and peritoneal dialysis are the preferred forms of dialysis delivery in critically ill children for the treatment of severe acute kidney injury. The epidemiology and the outcome of acute pediatric dialysis will be reviewed.

SUMMARY

The prospective pediatric CRRT (pCRRT) registry has provided important epidemiologic information: pCRRT is required in about 5% of patients in pediatric intensive care units, and the mortality rate of these patients is about 60%. CRRT outcomes are significantly associated with age, the presence of multiple organ dysfunction syndrome and the amount of fluid overload in children before CRRT inception. The timing and the dose of pCRRT are to be further evaluated in prospective trials. A final aspect worthy of review is a technical issue: the accuracy of new-generation CRRT monitors and novel dedicated circuits that have been developed. In future years, the delivery and the outcome of pCRRT are expected to significantly improve, with the target of expanding and anticipating dialysis initiation in critically ill pediatric patients.