Pediatric renal replacement therapy in the intensive care unit

Abstract

Renal replacement therapy (RRT) is used in a wide variety of pediatric populations. In this article, we will review the advantages and disadvantages of the different RRT modalities and the technical aspects of providing pediatric RRT. In addition, we will review the use of RRT with extracorporeal membrane oxygenation, the use of continuous RRT in the critically ill child with acute kidney injury and fluid overload, and the use of RRT for the removal of toxins and treatment of inborn errors of metabolism.

Figure 1. A detailed step-by-step protocol which mixes PRBCs and sodium bicarbonate using a Y-connector

Figure 2. Schematic of an in-line hemofilter added to an ECMO circuit

Blood from the oxygenator is drained via a three-way stopcock and pigtail tubing (A) to the hemofilter. An alternate connection (B) can be made. Hemofilter circuit blood returns to circuit tubing (C) and a three-way stopcock to the venous bladder. Hemofilter ultrafiltrate is drained by an automated pump (D) and collected and measured with an urometer. An IV pump (E) can be used to supply filter replacement fluids. An electronic flow probe (F) measures actual postmembrane flow for calculation of hemofilter ‘runoff’. Reprinted with permission from Hoover et al. [62].

Figure 3. Schematic of the inclusion of a CRRT device into an ECMO circuit with a centrifugal pump

Reprinted with permission from Santiago et al. [63].