Continuous Renal Replacement Therapy in Critically Ill Children in the Pediatric Intensive Care Unit: A Retrospective Analysis of Real-Life Prescriptions, Complications, and Outcomes
Introduction: Severe acute kidney injury is a common finding in the Pediatric Intensive Care Unit (PICU), however, Continuous Renal Replacement Therapy (CRRT) is rarely applied in this setting. This study aims to describe our experience in the rate of application of CRRT, patients' clinical cha...
Main Authors: | , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Frontiers Media S.A.
2021-06-01
|
Series: | Frontiers in Pediatrics |
Subjects: | |
Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2021.696798/full |
id |
doaj-86e5c4b24d7343c3970e8ee1e7c8a6ca |
---|---|
record_format |
Article |
spelling |
doaj-86e5c4b24d7343c3970e8ee1e7c8a6ca2021-06-14T06:49:03ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602021-06-01910.3389/fped.2021.696798696798Continuous Renal Replacement Therapy in Critically Ill Children in the Pediatric Intensive Care Unit: A Retrospective Analysis of Real-Life Prescriptions, Complications, and OutcomesEmanuele Buccione0Emanuele Buccione1Francesco Guzzi2Francesco Guzzi3Denise Colosimo4Brigida Tedesco5Stefano Romagnoli6Stefano Romagnoli7Zaccaria Ricci8Zaccaria Ricci9Manuela L'Erario10Gianluca Villa11Gianluca Villa12Pediatric Intensive Care Unit, Meyer Children's University Hospital, Florence, ItalyNeonatal Intensive Care Unit, AUSL Pescara, Pescara, ItalyNephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, ItalyDepartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, ItalyPediatric Intensive Care Unit, Meyer Children's University Hospital, Florence, ItalyPediatric Intensive Care Unit, Meyer Children's University Hospital, Florence, ItalySection of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, ItalyDepartment of Anesthesia and Intensive Care, AOU Careggi, Florence, ItalyPediatric Intensive Care Unit, Meyer Children's University Hospital, Florence, ItalySection of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, ItalyPediatric Intensive Care Unit, Meyer Children's University Hospital, Florence, ItalySection of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, ItalyDepartment of Anesthesia and Intensive Care, AOU Careggi, Florence, ItalyIntroduction: Severe acute kidney injury is a common finding in the Pediatric Intensive Care Unit (PICU), however, Continuous Renal Replacement Therapy (CRRT) is rarely applied in this setting. This study aims to describe our experience in the rate of application of CRRT, patients' clinical characteristics at admission and CRRT initiation, CRRT prescription, predictors of circuit clotting, short- and long-term outcomes.Methods: A 6-year single center retrospective study in a tertiary PICU.Results: Twenty-eight critically ill patients aged 0 to 18 years received CRRT between January 2012 and December 2017 (1.4% of all patients admitted to PICU). Complete clinical and CRRT technical information were available for 23/28 patients for a total of 101 CRRT sessions. CRRT was started, on average, 40 h (20–160) after PICU admission, mostly because of fluid overload. Continuous veno-venous hemodiafiltration and systemic heparinization were applied in 83.2 and 71.3% of sessions, respectively. Fifty-nine sessions (58.4%) were complicated by circuit clotting. At multivariate Cox-regression analysis, vascular access caliber larger than 8 Fr [HR 0.37 (0.19–0.72), p = 0.004] and regional citrate anticoagulation strategy [HR 0.14 (0.03–0.60), p = 0.008] were independent protective factors for clotting. PICU mortality rate was 42.8%, and six survivors developed chronic kidney disease (CKD), within an average follow up of 3.5 years.Conclusions: CRRT is uncommonly applied in our PICU, mostly within 2 days after admission and because of fluid overload. Larger vascular access and citrate anticoagulation are independent protective factors for circuit clotting. Patients' PICU mortality rate is high and survival often complicated by CKD development.https://www.frontiersin.org/articles/10.3389/fped.2021.696798/fullacute kidney injuryhemodialysisartificial membranesblood clottingvascular catheterschronic kidney disease |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Emanuele Buccione Emanuele Buccione Francesco Guzzi Francesco Guzzi Denise Colosimo Brigida Tedesco Stefano Romagnoli Stefano Romagnoli Zaccaria Ricci Zaccaria Ricci Manuela L'Erario Gianluca Villa Gianluca Villa |
spellingShingle |
Emanuele Buccione Emanuele Buccione Francesco Guzzi Francesco Guzzi Denise Colosimo Brigida Tedesco Stefano Romagnoli Stefano Romagnoli Zaccaria Ricci Zaccaria Ricci Manuela L'Erario Gianluca Villa Gianluca Villa Continuous Renal Replacement Therapy in Critically Ill Children in the Pediatric Intensive Care Unit: A Retrospective Analysis of Real-Life Prescriptions, Complications, and Outcomes Frontiers in Pediatrics acute kidney injury hemodialysis artificial membranes blood clotting vascular catheters chronic kidney disease |
author_facet |
Emanuele Buccione Emanuele Buccione Francesco Guzzi Francesco Guzzi Denise Colosimo Brigida Tedesco Stefano Romagnoli Stefano Romagnoli Zaccaria Ricci Zaccaria Ricci Manuela L'Erario Gianluca Villa Gianluca Villa |
author_sort |
Emanuele Buccione |
title |
Continuous Renal Replacement Therapy in Critically Ill Children in the Pediatric Intensive Care Unit: A Retrospective Analysis of Real-Life Prescriptions, Complications, and Outcomes |
title_short |
Continuous Renal Replacement Therapy in Critically Ill Children in the Pediatric Intensive Care Unit: A Retrospective Analysis of Real-Life Prescriptions, Complications, and Outcomes |
title_full |
Continuous Renal Replacement Therapy in Critically Ill Children in the Pediatric Intensive Care Unit: A Retrospective Analysis of Real-Life Prescriptions, Complications, and Outcomes |
title_fullStr |
Continuous Renal Replacement Therapy in Critically Ill Children in the Pediatric Intensive Care Unit: A Retrospective Analysis of Real-Life Prescriptions, Complications, and Outcomes |
title_full_unstemmed |
Continuous Renal Replacement Therapy in Critically Ill Children in the Pediatric Intensive Care Unit: A Retrospective Analysis of Real-Life Prescriptions, Complications, and Outcomes |
title_sort |
continuous renal replacement therapy in critically ill children in the pediatric intensive care unit: a retrospective analysis of real-life prescriptions, complications, and outcomes |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Pediatrics |
issn |
2296-2360 |
publishDate |
2021-06-01 |
description |
Introduction: Severe acute kidney injury is a common finding in the Pediatric Intensive Care Unit (PICU), however, Continuous Renal Replacement Therapy (CRRT) is rarely applied in this setting. This study aims to describe our experience in the rate of application of CRRT, patients' clinical characteristics at admission and CRRT initiation, CRRT prescription, predictors of circuit clotting, short- and long-term outcomes.Methods: A 6-year single center retrospective study in a tertiary PICU.Results: Twenty-eight critically ill patients aged 0 to 18 years received CRRT between January 2012 and December 2017 (1.4% of all patients admitted to PICU). Complete clinical and CRRT technical information were available for 23/28 patients for a total of 101 CRRT sessions. CRRT was started, on average, 40 h (20–160) after PICU admission, mostly because of fluid overload. Continuous veno-venous hemodiafiltration and systemic heparinization were applied in 83.2 and 71.3% of sessions, respectively. Fifty-nine sessions (58.4%) were complicated by circuit clotting. At multivariate Cox-regression analysis, vascular access caliber larger than 8 Fr [HR 0.37 (0.19–0.72), p = 0.004] and regional citrate anticoagulation strategy [HR 0.14 (0.03–0.60), p = 0.008] were independent protective factors for clotting. PICU mortality rate was 42.8%, and six survivors developed chronic kidney disease (CKD), within an average follow up of 3.5 years.Conclusions: CRRT is uncommonly applied in our PICU, mostly within 2 days after admission and because of fluid overload. Larger vascular access and citrate anticoagulation are independent protective factors for circuit clotting. Patients' PICU mortality rate is high and survival often complicated by CKD development. |
topic |
acute kidney injury hemodialysis artificial membranes blood clotting vascular catheters chronic kidney disease |
url |
https://www.frontiersin.org/articles/10.3389/fped.2021.696798/full |
work_keys_str_mv |
AT emanuelebuccione continuousrenalreplacementtherapyincriticallyillchildreninthepediatricintensivecareunitaretrospectiveanalysisofreallifeprescriptionscomplicationsandoutcomes AT emanuelebuccione continuousrenalreplacementtherapyincriticallyillchildreninthepediatricintensivecareunitaretrospectiveanalysisofreallifeprescriptionscomplicationsandoutcomes AT francescoguzzi continuousrenalreplacementtherapyincriticallyillchildreninthepediatricintensivecareunitaretrospectiveanalysisofreallifeprescriptionscomplicationsandoutcomes AT francescoguzzi continuousrenalreplacementtherapyincriticallyillchildreninthepediatricintensivecareunitaretrospectiveanalysisofreallifeprescriptionscomplicationsandoutcomes AT denisecolosimo continuousrenalreplacementtherapyincriticallyillchildreninthepediatricintensivecareunitaretrospectiveanalysisofreallifeprescriptionscomplicationsandoutcomes AT brigidatedesco continuousrenalreplacementtherapyincriticallyillchildreninthepediatricintensivecareunitaretrospectiveanalysisofreallifeprescriptionscomplicationsandoutcomes AT stefanoromagnoli continuousrenalreplacementtherapyincriticallyillchildreninthepediatricintensivecareunitaretrospectiveanalysisofreallifeprescriptionscomplicationsandoutcomes AT stefanoromagnoli continuousrenalreplacementtherapyincriticallyillchildreninthepediatricintensivecareunitaretrospectiveanalysisofreallifeprescriptionscomplicationsandoutcomes AT zaccariaricci continuousrenalreplacementtherapyincriticallyillchildreninthepediatricintensivecareunitaretrospectiveanalysisofreallifeprescriptionscomplicationsandoutcomes AT zaccariaricci continuousrenalreplacementtherapyincriticallyillchildreninthepediatricintensivecareunitaretrospectiveanalysisofreallifeprescriptionscomplicationsandoutcomes AT manuelalerario continuousrenalreplacementtherapyincriticallyillchildreninthepediatricintensivecareunitaretrospectiveanalysisofreallifeprescriptionscomplicationsandoutcomes AT gianlucavilla continuousrenalreplacementtherapyincriticallyillchildreninthepediatricintensivecareunitaretrospectiveanalysisofreallifeprescriptionscomplicationsandoutcomes AT gianlucavilla continuousrenalreplacementtherapyincriticallyillchildreninthepediatricintensivecareunitaretrospectiveanalysisofreallifeprescriptionscomplicationsandoutcomes |
_version_ |
1721378600012218368 |