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Prolonged intermittent renal replacement therapy in children.

Authors
  • Sinha, Rajiv1
  • Sethi, Sidharth Kumar2
  • Bunchman, Timothy3
  • Lobo, Valentine4
  • Raina, Rupesh5
  • 1 Institute of Child Health and AMRI Hospital, 37, G Bondel Road, Kolkata, West Bengal, 700019, India. [email protected] , (India)
  • 2 Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India. , (India)
  • 3 Pediatric Nephrology, Children's Hospital of Richmond at VCU, Richmond, VA, USA.
  • 4 Department of Nephrology, KEM Hospital, Pune, Maharashtra, India. , (India)
  • 5 Pediatric Nephrology, Akron Children's Hospital, Cleveland, OH, USA.
Type
Published Article
Journal
Pediatric Nephrology
Publisher
Springer-Verlag
Publication Date
Jul 18, 2017
Identifiers
DOI: 10.1007/s00467-017-3732-2
PMID: 28721515
Source
Medline
Keywords
License
Unknown

Abstract

Wide ranges of age and weight in pediatric patients makes renal replacement therapy (RRT) in acute kidney injury (AKI) challenging, particularly in the pediatric intensive care unit (PICU), wherein children are often hemodynamically unstable. Standard hemodialysis (HD) is difficult in this group of children and continuous veno-venous hemofiltration/dialysis (CVVH/D) has been the accepted modality in the developed world. Unfortunately, due to cost constraints, CVVH/D is often not available and peritoneal dialysis (PD) remains the common mode of RRT in resource-poor facilities. Acute PD has its drawbacks, and intermittent HD (IHD) done slowly over a prolonged period has been explored as an alternative. Various modes of slow sustained IHD have been described in the literature with the recently introduced term prolonged intermittent RRT (PIRRT) serving as an umbrella terminology for all of these modes. PIRRT has been widely accepted in adults with studies showing it to be as effective as CVVH/D but with an added advantage of being more cost-effective. Pediatric data, though scanty, has been promising. In this current review, we elaborate on the practical aspects of undertaking PIRRT in children as well as summarize its current status.

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