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Author Notes:

Corresponding Author: David J Askenazi, MD., MsPH. University of Alabama at Birmingham, Department of Pediatrics, Division of Nephrology, 1600 7th Ave South, ACC 516, Birmingham, AL 35233. daskenazi@peds.uab.edu

The authors acknowledge the help of Deepa Chan, Steven Alexander, Mark Benfield, Cathy DiMuzio (Gambro Renal Products), Walter O’Rourke (Dialysis Solutions), Joe Villanova (Baxter Healthcare), and Tony Annone (B Braun, Inc) for their support of the ppCRRT.

The authors thank the wonderful nurses, research assistants, and physicians at all of the institutions involved in the ppCRRT for their diligent care of children and assistance in making this registry a success.

See publication for full list of disclosures.

Subjects:

Research Funding:

ppCRRT received unrestricted grant funding from Gam- bro Renal Products, Dialysis Solutions, Inc, Baxter Healthcare, and B Braun, Inc.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Pediatrics
  • PEDIATRICS
  • ACUTE LUNG INJURY
  • PPCRRT REGISTRY
  • FLUID BALANCE
  • MORTALITY
  • FAILURE
  • VOLUME
  • CRRT
  • Acute kidney injury
  • Continuous renal replacement therapy
  • Percent FO
  • Fluid overload
  • ICU
  • Paw
  • Mean airway pressure
  • ppCRRT
  • AKI
  • CRRT
  • %FO
  • Prospective pediatric continuous renal replacement therapy
  • PRISM
  • Pediatric risk of mortality

Continuous Renal Replacement Therapy for Children <= 10 kg: A Report from the Prospective Pediatric Continuous Renal Replacement Therapy Registry

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Journal Title:

Journal of Pediatrics

Volume:

Volume 162, Number 3

Publisher:

, Pages 587-592.e3

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Objective: To report circuit characteristics and survival analysis in children weighing ≤10 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 ≤10 kg compared with other children; (2) determine demographic and clinical differences between surviving and non-surviving children ≤10 kg; and (3) describe continuous renal replacement therapy (CRRT) circuit characteristics differences in children ≤5 kg versus 5-10 kg. Results: The ppCRRT enrolled 84 children ≤10 kg between January 2001 and August 2005 from 13 US tertiary centers. Children ≤10 kg had lower survival rates than children > 10 kg (36/84 [43%] versus 166/260 [64%] ; P < .001). In children ≤10 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 ≤5 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 ≤10 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.

Copyright information:

© 2013 Mosby Inc.

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