Metabolic disturbances encountered during pediatric continuous renal replacement therapy

Objective

Continuous renal replacement therapy (CRRT) has become an important supportive therapy for critically ill children with acute renal failure. In Turkey commercially available diafiltration and replacement fluids cannot be found on the market. Instead, peritoneal dialysis fluids for dialysis and normal saline as replacement fluid are used. The first objective of this study is to examine the metabolic complications due to CRRT treatments. The second objective is to determine demographic characteristics and outcomes of the patients that receive CRRT.

Methods

A retrospective chart review in a university hospital.

Patients

All pediatric patients treated with CRRT between February 2004 and December 2004.

Measurements and results

Thirteen patients received CRRT; seven survived (53.8%). All patients were treated with continuous veno-venous hemodiafiltration. The median patient age was 71.8 ± 78.8 (1.5–180) months. Blood flow rates varied from 20 to 150 ml/min. Ultrafiltration and dialysis rate ranges were 90–130 ml/1.73 m²/hour and 200–1085 ml/1.73 m²/hour, respectively. The replacement fluid dose was 17.1 ± 13.5 ml/kg/hour (5–37). Hyperglycemia occurred in 76.9% (n = 10) and metabolic acidosis occurred in 53.8% (n = 7) of the patients. The median age was lower (48.8 vs 106.2 months), the median urea level (106.2 vs 71 mg/dl) and %FO (17.2% vs 7.6%) were higher, and the CRRT initiation time was longer (8.6 vs 5.6 days) in nonsurvivors vs survivors for all patients, although not statistically significant. CRRT was stopped all of the survivors, and four of the nonsurvivors (67%) were on renal replacement therapy at the time of death.

Conclusion

Hyperglycemia and metabolic acidosis was frequently seen in CRRT patients when commercially available diafiltration fluids were not available. Early initiation of CRRT offered survival benefit to critically ill pediatric patients. The mortality is associated with the primary disease diagnosis.