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Review
. 2020 Jun;32(3):360-366.
doi: 10.1097/MOP.0000000000000894.

Renal replacement therapies for infants and children in the ICU

Keia R Sanderson  1 , Lyndsay A Harshman  2
Affiliations
Review

Renal replacement therapies for infants and children in the ICU

Keia R Sanderson et al. Curr Opin Pediatr. 2020 Jun.

Abstract

Purpose of review: Pediatric acute kidney injury (AKI) in critically ill patients is associated with increased morbidity and mortality. Emerging data support that the incidence of pediatric AKI in the ICU is rising. For children with severe AKI, renal replacement therapy (RRT) can provide a lifesaving supportive therapy. The optimal timing to deliver and modality by which to deliver RRT remain a point of discussion within pediatric (and adult) literature. This review discusses the use of RRT for pediatric patients in the ICU. We discuss the most recent evidence-based methods for RRT with a focus on continuous RRT.

Recent findings: The feasibility of dialyzing the smallest infants and more medically complex children in the ICU is dependent on the advancements in dialysis access and circuit technology. At present, data indicate that upward of 27% of children in the ICU develop AKI and 6% require RRT. Newer dialysis modalities including prolonged intermittent hemodialysis and continuous flow peritoneal dialysis as well as newer dialysis technologies such as the smaller volume circuits (e.g., Cardio-Renal Pediatric Dialysis Emergency Machine, Newcastle Infant Dialysis and Ultrafiltration System) have made the provision of dialysis safer and more effective for pediatric patients of a variety of sizes.

Summary: Renal replacement in the ICU requires a multidisciplinary team approach that is facilitated by a pediatric nephrologist in conjunction with intensivists and skilled nursing staff. Although mortality rates for children on dialysis remain high, outcomes are improving with the support of the multidisciplinary team and dialysis technology advancements.

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Conflict of interest statement

Conflicts of interest

There are no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Size is a critical limitation for use of dialysis equipment in neonates. An 800-g infant is pictured here with use of standard peritoneal dialysis equipment [34]. Note that standard equipment was placed in the left upper quadrant to allow for adequate positioning of the catheter within the peritoneum.
See this image and copyright information in PMC

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