Sravani Madhileti, Krishnasamy Sudarsan, Deepthi Bobbity, Bc Gowtham, Palanisamy Sivamurukan, Parameswaran Narayanan, Krishnamurthy Sriram
Pediatric Nephrology Services, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
Pediatric Intensive Care Services, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
Pediatr Nephrol. 2025 Jun;40(6):2083-2090. doi: 10.1007/s00467-025-06674-9. Epub 2025 Jan 31.
Information on the clinical characteristics and outcomes of children undergoing continuous kidney replacement therapy (CKRT) from lower-middle-income countries (LMIC) is limited.
Records of consecutive children 1 month to 18 years of age who underwent CKRT from Jan 2016 to Jan 2024 in a tertiary care pediatric intensive care unit (PICU) were retrospectively reviewed and analyzed for clinical and machine-related characteristics, and outcomes.
Over the 8-year period, 102 patients (61.8% boys) with median age 4 (1.5-9) years underwent CKRT. Among these, 52 (51%) weighed < 15 kg, 37 (36.3%) were underweight, and 27 (26.5%) were stunted. Mean (SD) PRISM III score at admission was 17 (6.8), with 94.1% of patients ventilated and 90.2% on two or more inotropes at CKRT initiation. Septic shock (28.4%) and inborn errors of metabolism with acute decompensation (23.5%) were the most common diagnoses at PICU admission. Indications for CKRT were fluid overload, hyperammonemia or inborn errors of metabolism with acute decompensation, dyselectrolytemia, or their combination in 33.3%, 32.4%, 5.9%, and 19.6% patients, respectively. Continuous veno-venous hemodiafiltration (CVVHDF) was the most common (60.8%) modality employed, with an effluent dose of 32.8 ± 7.3 ml/kg/h. Despite heparin anticoagulation in 87.2% patients, circuit clot occurred in 28 patients, 18 (17.6%) of which led to termination of CKRT session. Overall mortality was 75%.
CKRT can be safely performed in critically ill children from LMIC despite the presence of significant undernutrition and multi-organ dysfunction. Further studies from similar settings are required to evolve strategies to identify modifiable risk factors for the observed high mortality.
来自中低收入国家（LMIC）的儿童接受持续肾脏替代治疗（CKRT）的临床特征和结局信息有限。
回顾性分析2016年1月至2024年1月在一家三级儿科重症监护病房（PICU）接受CKRT的1个月至18岁连续儿童的记录，分析其临床和机器相关特征及结局。
在这8年期间，102例患者（61.8%为男孩）接受了CKRT，中位年龄为4岁（1.5 - 9岁）。其中，52例（51%）体重<15 kg，37例（36.3%）体重不足，27例（26.5%）发育迟缓。入院时PRISM III评分的平均值（标准差）为17（6.8），94.1%的患者接受通气，90.2%的患者在开始CKRT时使用两种或更多种血管活性药物。脓毒性休克（28.4%）和伴有急性失代偿的先天性代谢缺陷（23.5%）是PICU入院时最常见的诊断。CKRT的适应证分别为液体超负荷、高氨血症或伴有急性失代偿的先天性代谢缺陷、电解质紊乱或其组合，分别占患者的33.3%、32.4%、5.9%和19.6%。持续静脉 - 静脉血液透析滤过（CVVHDF）是最常用的模式（60.8%），超滤剂量为32.8±7.3 ml/kg/h。尽管87.2%的患者使用肝素抗凝，但28例患者出现了管路凝血，其中18例（17.6%）导致CKRT治疗终止。总体死亡率为75%。
尽管存在严重营养不良和多器官功能障碍，但来自中低收入国家的危重症儿童可以安全地进行CKRT。需要在类似环境中进行进一步研究，以制定策略来识别观察到的高死亡率的可改变风险因素。
