Continuous Renal Replacement Therapy for Children ¡Ü10 kg: A Report from the Prospective Pediatric Continuous Renal Replacement Therapy Registry

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• 作者：David J. Askenazi ; MD ; MSPH¹ ; ^{daskenazi@peds.uab.edu} ; Stuart L. Goldstein ; MD² ; Rajesh Koralkar ; MBBS ; MPH¹ ; James Fortenberry ; MD³ ; Michelle Baum ; MD⁴ ; Richard Hackbarth ; MD⁵ ; Doug Blowey ; MD⁶ ; Timothy E. Bunchman ; MD⁷ ; Patrick D. Brophy ; MD⁸ ; Jordan Symons ; MD⁹ ; Annabelle Chua ; MD¹⁰ ; Francisco Flores ; MD¹¹ ; Michael J.G. Somers ; MD⁴
• 关键词：AKI ; Acute kidney injury ; CRRT ; Continuous renal replacement therapy ; % FO ; Percent FO ; FO ; Fluid overload ; ICU ; Intensive care unit ; Paw ; Mean airway pressure ; ppCRRT ; Prospective Pediatric Continuous Renal Replacement Therapy ; PRISM ; Pediatric Risk of Mo
• 刊名：The Journal of Pediatrics
• 出版年：2013
• 出版时间：March, 2013
• 年：2013
• 卷：162
• 期：3
• 页码：587-592.e3
• 全文大小：215 K

文摘

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Objective

To report circuit characteristics and survival analysis in children weighing ¡Ü10 kg enrolled in the Prospective Pediatric Continuous Renal Replacement Therapy (ppCRRT) Registry.

Study design

We conducted prospective cohort analysis of the ppCRRT Registry to: (1) evaluate survival differences in children ¡Ü10 kg compared with other children; (2) determine demographic and clinical differences between surviving and non-surviving children ¡Ü10 kg; and (3) describe continuous renal replacement therapy (CRRT) circuit characteristics differences in children ¡Ü5 kg versus 5-10 kg.

Results

The ppCRRT enrolled 84 children ¡Ü10 kg between January 2001 and August 2005 from 13 US tertiary centers. Children ¡Ü10 kg had lower survival rates than children &gt;10 kg (36/84 [43 % ] versus 166/260 [64 % ]; P?<?.001). In children ¡Ü10 kg, survivors were more likely to have fewer days in intensive care unit prior to CRRT, lower Pediatric Risk of Mortality 2 scores at intensive care unit admission and lower mean airway pressure (P_aw), higher urine output, and lower percent fluid overload (FO) at CRRT initiation. Adjusted regression analysis revealed that Pediatric Risk of Mortality 2 scores, FO, and decreased urine output were associated with mortality. Compared with circuits from children 5-10 kg at CRRT initiation, circuits from children ¡Ü5 kg more commonly used blood priming for initiation, heparin anticoagulation, and higher blood flows/effluent flows for body weight.

Conclusion

Mortality is more common in children who are ¡Ü10 kg at the time of CRRT initiation. Like other CRRT populations, urine output and FO at CRRT initiation are independently associated with mortality. CRRT prescription differs in small children.