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Intensive Care Medicine

Published in:

01-04-2009 | Review

Controversies in paediatric continuous renal replacement therapy

Authors: Graeme MacLaren, Warwick Butt

Published in: Intensive Care Medicine | Issue 4/2009

Abstract

Background

Continuous renal replacement therapy (CRRT) is an invaluable means of supporting critically ill children with many illnesses, including acute renal failure, drug intoxication, inborn errors of metabolism, and multiorgan failure. However, the ideal method of applying the technique is unknown.

Discussion

The indications for initiation of CRRT, mode, dose, and means of anticoagulating the circuit to prolong filter life are all subjects of controversy. The formation of a prospective, multicentre paediatric CRRT registry has been a major step forward but large, randomised trials of the sort that exist in adult medicine are lacking. This review describes the basic technique of CRRT, highlights the differences between adult and paediatric prescription, and elaborates on the main controversies in the application of CRRT in children.

Conclusions

Current evidence suggests that early initiation of CRRT before the onset of substantial fluid overload, considering continuous haemofiltration in disease states such as respiratory failure following stem cell transplantation, and the use of continuous haemodialysis and citrate anticoagulation to prolong circuit life may be associated with improved outcomes.

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Title: Controversies in paediatric continuous renal replacement therapy
Authors: Graeme MacLaren
Warwick Butt
Publication date: 01-04-2009
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 4/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-009-1425-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Controversies in paediatric continuous renal replacement therapy

Abstract

Background

Discussion

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Discussion

Conclusions

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