Seven years of Continuous Renal Replacement Therapy
(CRRT) in the Pediatric and Neonatal Intensive Care:
a single centre experience
L. Koster-Kamphuis1, J. Lemson2, A. van Heijst3, M. Cornelissen1.
Objectives A retrospective analysis of all critically ill children treated
in our hospital with CRRT since the introduction in 2003 is performed.
Methods Using the PRISMA machine (Gambro) we treated 59 patients.
23 patients while on Extra Corporeal Membrane Oxygenation
(ECMO). The M10 filter (n=9), the M60 filter (n=47) and the M100
filter (n=6) were used. ECMO circuit (n=23), femoral vein (n=16),
jugular vein (n=10), subclavian vein (n=4), other (n=6) were used as
vascular access. Heparin was used as anticoagulant in most cases.
Results Age was 2 days to 16 years (bodyweight 2.1 – 53 kg).
Treatment duration was 2 hours to 37 days. Indications for treatment
were fluid overload with (n=16) or without renal failure (n=18),
acute kidney failure (n=9), hyperammonemia (n=9), MOF (n=8),
miscellaneous (n=2). Underlying disorders were congenital heart
defect (n=17), inborn error of metabolism (n=8), malignancy (n=7),
sepsis (n=5), respiratory failure (n=5), congenital diaphragmatic hernia
(n=6), HUS (n=3), miscellaneous (n=8). 26 patients died (44%).
In 7 patients death occurred after recovery of kidney function. In 14
patients all treatment was stopped due to poor prognosis. Five patients
died despite all treatment given. Some bleeding complications were
seen. No deaths were caused by complication of the CRRT itself.
Conclusion CRRT has become a routine treatment modality in our PICU
and NICU. It offers more expanded treatment options for very ill (small)
children. Deaths were caused by the severity of the underlying
disorder and by the severity of the illness at the time of treatment.
Presenting and corresponding author:
Linda Koster-Kamphuis
Radboud University Nijmegen Medical Centre, The Netherlands
Dept. of 1Pediatric Nephrology, 2 Pediatric Intensive Care, 3 Neonatology
HP 804
PO box 9101
6500 HB Nijmegen
The Netherlands
Phone: +31243666292
Fax:
+31243619348
E-mail: l.koster@cukz.umcn.nl