Division of Nephrology and Hypertension, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA.
The Kidney and Urinary Tract Center, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 430205, USA.
Pediatr Nephrol. 2023 Jul;38(7):2043-2055. doi: 10.1007/s00467-022-05768-y. Epub 2022 Oct 13.
Kidney support therapy (KST), previously referred to as Renal Replacement Therapy, is utilized to treat children and adults with severe acute kidney injury (AKI), fluid overload, inborn errors of metabolism, and kidney failure. Several forms of KST are available including peritoneal dialysis (PD), intermittent hemodialysis (iHD), and continuous kidney support therapy (CKST). Traditionally, extracorporeal KST (CKST and iHD) in neonates has had unique challenges related to small patient size, lack of neonatal-specific devices, and risk of hemodynamic instability due to large extracorporeal circuit volume relative to patient total blood volume. Thus, PD has been the most commonly used modality in infants, followed by CKST and iHD. In recent years, CKST machines designed for small children and novel filters with smaller extracorporeal circuit volumes have emerged and are being used in many centers to provide neonatal KST for toxin removal and to achieve fluid and electrolyte homeostasis, increasing the options available for this unique and vulnerable group. These new treatment options create a dramatic paradigm shift with recalibration of the benefit: risk equation. Renewed focus on the infrastructure required to deliver neonatal KST safely and effectively is essential, especially in programs/units that do not traditionally provide KST to neonates. Building and implementing a neonatal KST program requires an expert multidisciplinary team with strong institutional support. In this review, we first describe the available neonatal KST modalities including newer neonatal and infant-specific platforms. Then, we describe the steps needed to develop and sustain a neonatal KST team, including recommendations for provider and nursing staff training. Finally, we describe how quality improvement initiatives can be integrated into programs.
肾脏支持治疗（KST），以前称为肾脏替代治疗，用于治疗患有严重急性肾损伤（AKI）、液体超负荷、先天性代谢错误和肾衰竭的儿童和成人。有几种形式的 KST 可用，包括腹膜透析（PD）、间歇性血液透析（iHD）和连续肾脏支持治疗（CKST）。传统上，新生儿的体外 KST（CKST 和 iHD）具有独特的挑战，与患者体型小、缺乏新生儿专用设备以及由于体外回路体积相对于患者总血容量较大而导致血流动力学不稳定的风险有关。因此，PD 一直是婴儿中最常用的方式，其次是 CKST 和 iHD。近年来，专为小儿设计的 CKST 机和具有较小体外回路体积的新型过滤器已经出现，并在许多中心用于为新生儿提供 KST 以去除毒素并实现液体和电解质平衡，为这个独特和脆弱的群体提供了更多的选择。这些新的治疗选择带来了戏剧性的范式转变，重新校准了效益：风险方程。重新关注提供新生儿 KST 安全有效的基础设施至关重要，特别是在传统上不向新生儿提供 KST 的计划/单位。建立和实施新生儿 KST 计划需要一个由专家组成的多学科团队，并得到强大的机构支持。在这篇综述中，我们首先描述了可用的新生儿 KST 方式，包括更新的新生儿和婴儿专用平台。然后，我们描述了建立和维持新生儿 KST 团队所需的步骤，包括为提供者和护理人员培训的建议。最后，我们描述了如何将质量改进计划纳入计划。
