Pediatric Nephrology Unit, Department for Women's and Children's Health, University-Hospital of Padua, Padua, Italy.
Department of Medicine (DAME), University of Udine, Udine, Italy.
Pediatr Nephrol. 2024 Jan;39(1):115-123. doi: 10.1007/s00467-023-05933-x. Epub 2023 Apr 4.
Advancements in pediatric dialysis generally rely on adaptation of technology originally developed for adults. However, in the last decade, particular attention has been paid to neonatal extracorporeal therapies for acute kidney care, an area in which technology has made giant strides in recent years. Peritoneal dialysis (PD) is the kidney replacement therapy (KRT) of choice in the youngest age group because of its simplicity and effectiveness. However, extracorporeal blood purification provides more rapid clearance of solutes and faster fluid removal. Hemodialysis (HD) and continuous KRT (CKRT) are thus the most used dialysis modalities for pediatric acute kidney injury (AKI) in developed countries. The utilization of extracorporeal dialysis for small children is associated with a series of clinical and technical challenges which have discouraged the use of CKRT in this population. The revolution in the management of AKI in newborns has started recently with the development of new CKRT machines for small infants. These new devices have a small extracorporeal volume that potentially prevents the use of blood to prime lines and dialyzer, allow a better volume control and the use of small-sized catheter without compromising the blood flow amount. Thanks to the development of new dedicated devices, we are currently dealing with a true "scientific revolution" in the management of neonates and infants who require an acute kidney support.
儿科透析的进展通常依赖于最初为成人开发的技术的改进。然而,在过去十年中,特别关注了新生儿急性肾脏护理的体外治疗,近年来该领域的技术取得了巨大进展。腹膜透析 (PD) 因其简单性和有效性而成为最年轻年龄组的首选肾脏替代疗法 (KRT)。然而,体外血液净化提供了更快的溶质清除率和更快的液体去除。因此,血液透析 (HD) 和连续肾脏替代疗法 (CKRT) 是发达国家小儿急性肾损伤 (AKI) 最常用的透析方式。由于小儿体外透析存在一系列临床和技术挑战,限制了 CKRT 在该人群中的应用。最近,随着新型小婴儿体外透析机的开发,新生儿 AKI 的管理发生了革命性变化。这些新设备具有较小的体外体积,可潜在地防止使用血液来预充管路和透析器,允许更好的容量控制和使用小尺寸的导管,而不会影响血流量。得益于新型专用设备的发展,我们目前正在处理新生儿和需要急性肾脏支持的婴儿管理方面的真正“科学革命”。