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Original Articles
Pediatrics
Prevalence of extracorporeal blood purification techniques in critically ill patients before and during the COVID-19 pandemic in Egypt
Aya Osama Mohammed, Hanaa I. Rady
Acute Crit Care. 2024;39(1):70-77.   Published online February 1, 2024
DOI: https://doi.org/10.4266/acc.2023.00654
  • 1,580 View
  • 112 Download
AbstractAbstract PDF
Background
Extracorporeal blood-purification techniques are frequently needed in the pediatric intensive care unit (PICU), yet data on their clinical application are lacking. This study aims to review the indications, rate of application, clinical characteristics, complications, and outcomes of patients undergoing extracorporeal blood purification (i.e., by continuous renal replacement therapy [CRRT] or therapeutic plasma exchange [TPE]) in our PICU, including before the coronavirus disease 2019 (COVID-19) pandemic in 2019 and during the pandemic from 2020 to 2022. Methods: This study included children admitted for extracorporeal blood-purification therapy in the PICU. The indications for TPE were analyzed and compared to the American Society for Apheresis categories. Results: In 82 children, 380 TPE sessions and 37 CRRT sessions were carried out children, with 65 patients (79%) receiving TPE, 17 (20.7%) receiving CRRT, and four (4.8%) receiving both therapies. The most common indications for TPE were neurological diseases (39/82, 47.5%), followed by hematological diseases (18/82, 21.9%). CRRT was mainly performed for patients suffering from acute kidney injury. Patients with neurological diseases received the greatest number of TPE sessions (295, 77.6%). Also, the year 2022 contained the greatest number of patients receiving extracorporeal blood-purification therapy (either CRRT or TPE). Conclusions: The use of extracorporeal blood-purification techniques increased from 2019 through 2022 due to mainly autoimmune dysregulation among affected patients. TPE can be safely used in an experienced PICU. No serious adverse events were observed in the patients that received TPE, and overall survival over the 4 years was 86.5%.
Nephrology
Epidemiology and outcome of an acute kidney injuries in the polytrauma victims admitted at the apex trauma center in Dubai
Bhushan Sudhakar Wankhade, Zeyad Faoor Alrais, Ghaya Zeyad Alrais, Ammar Mohamed Abdel Hadi, Gopala Arun Kumar Naidu, Mohammed Shahid Abbas, Ahmed Tarek Youssef Aboul Kheir, Hasan Hadad, Sundareswaran Sharma, Mohammad Sait
Acute Crit Care. 2023;38(2):217-225.   Published online May 25, 2023
DOI: https://doi.org/10.4266/acc.2023.00388
  • 2,003 View
  • 81 Download
AbstractAbstract PDF
Background
Polytrauma from road accidents is a common cause of hospital admissions and deaths, frequently leading to acute kidney injury (AKI) and impacting patient outcomes. Methods: This retrospective, single-center study included polytrauma victims with an Injury Severity Score (ISS) >25 at a tertiary healthcare center in Dubai. Results: The incidence of AKI in polytrauma victims is 30.5%, associated with higher Carlson comorbidity index (P=0.021) and ISS (P=0.001). Logistic regression shows a significant relationship between ISS and AKI (odds ratio [OR], 1.191; 95% confidence interval [CI], 1.150–1.233; P<0.05). The main causes of trauma-induced AKI are hemorrhagic shock (P=0.001), need for massive transfusion (P<0.001), rhabdomyolysis (P=0.001), and abdominal compartment syndrome (ACS; P<0.001). On multivariate logistic regression AKI can be predicated by higher ISS (OR, 1.08; 95% CI, 1.00–1.17; P=0.05) and low mixed venous oxygen saturation (OR, 1.13; 95% CI, 1.05–1.22; P<0.001). The development of AKI after polytrauma increases length of stay (LOS)-hospital (P=0.006), LOS-intensive care unit (ICU; P=0.003), need for mechanical ventilation (MV) (P<0.001), ventilator days (P=0.001), and mortality (P<0.001). Conclusions: After polytrauma, the occurrence of AKI leads to prolonged hospital and ICU stays, increased need for mechanical ventilation, more ventilator days, and a higher mortality rate. AKI could significantly impact their prognosis.
Nephrology
Impact of intradialytic hypotension on mortality following the transition from continuous renal replacement therapy to intermittent hemodialysis
Seong Geun Kim, Donghwan Yun, Jinwoo Lee, Yong Chul Kim, Dong Ki Kim, Kook-Hwan Oh, Kwon Wook Joo, Yon Su Kim, Seung Seok Han
Acute Crit Care. 2023;38(1):86-94.   Published online October 26, 2022
DOI: https://doi.org/10.4266/acc.2022.00948
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  • 147 Download
AbstractAbstract PDF
Background
The transition of dialysis modalities from continuous renal replacement therapy (CRRT) to intermittent hemodialysis (iHD) is frequently conducted during the recovery phase of critically ill patients with acute kidney injury. Herein, we addressed the occurrence of intradialytic hypotension (IDH) after this transition, and its association with the mortality risk. Methods: A total of 541 patients with acute kidney injury who attempted to transition from CRRT to iHD at Seoul National University Hospital, Korea from 2010 to 2020 were retrospectively collected. IDH was defined as a discontinuation of dialysis because of hemodynamic instability plus a nadir systolic blood pressure <90 mm Hg or a decrease in systolic blood pressure ≥30 mm Hg during the first session of iHD. Odds ratios (ORs) of outcomes, such as in-hospital mortality and weaning from RRT, were measured using a logistic regression model after adjusting for multiple variables. Results: IDH occurred in 197 patients (36%), and their mortality rate (44%) was higher than that of those without IDH (19%; OR, 2.64; 95% confidence interval [CI], 1.70–4.08). For patients exhibiting IDH, the iHD sessions delayed successful weaning from RRT (OR, 0.62; 95% CI, 0.43–0.90) compared with sessions on those without IDH. Factors such as low blood pressure, high pulse rate, low urine output, use of mechanical ventilations and vasopressors, and hypoalbuminemia were associated with IDH risk. Conclusions: IDH occurrence following the transition from CRRT to iHD is associated with high mortality and delayed weaning from RRT.
Case Report
Nephrology
Continuous renal replacement therapy increased plasma cholinesterase activity in a case of acute organophosphate poisoning
In Ho Kwon, Jinwoo Jeong, Yuri Choi
Acute Crit Care. 2022;37(4):669-671.   Published online November 16, 2021
DOI: https://doi.org/10.4266/acc.2021.00780
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  • 171 Download
  • 2 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Extracorporeal removal of organophosphate from blood has been proposed, but the efficacy of hemodialysis and hemoperfusion has not been established. We report a case of organophosphate poisoning in which continuous renal replacement therapy (CRRT) was applied with conventional indications and was found to increase plasma cholinesterase levels by hemodiafiltration. A 73-year-old male was found unconscious at home and was brought to the emergency department by ambulance. An empty bottle of Supracide insecticide, of which the active ingredient is methidathion, was found beside him. CRRT was initiated because he showed signs of oliguria and acidosis with an unstable hemodynamic condition. Although his condition improved temporarily after CRRT initiation, it subsequently deteriorated, and he died despite maximal supportive effort. His prefilter plasma cholinesterase levels remained at <200 U/L for 3 days, while his postfilter levels were 358 U/L 1 hour after CRRT initiation and they were 689 U/L 18 hours later. Our case suggests that CRRT might play a role in treating organophosphate poisoning by possibly eliminating organophosphate.

Citations

Citations to this article as recorded by  
  • Advancements in bioscavenger mediated detoxification of organophosphorus poisoning
    Hexi Li, Cong Lu, Zhenmin Liu, Fengshun Xiang, Bo Liu, Hongjuan Wang, Jie Chang, Li Pan, Youwei Chen, Jingfei Chen
    Toxicology Research.2024;[Epub]     CrossRef
Original Article
Nephrology
Utility of Volume Assessment Using Bioelectrical Impedance Analysis in Critically Ill Patients Receiving Continuous Renal Replacement Therapy: A Prospective Observational Study
Ki Hyun Park, Jung-ho Shin, Jin Ho Hwang, Su Hyun Kim
Korean J Crit Care Med. 2017;32(3):256-264.   Published online August 31, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00136
  • 7,284 View
  • 164 Download
  • 14 Web of Science
  • 16 Crossref
AbstractAbstract PDF
Background
Fluid overload prior to continuous renal replacement therapy (CRRT) is an important prognostic factor. Thus, precise evaluation of fluid status is necessary to treat such patients. In this study, we investigated whether fluid assessment using bioelectrical impedance analysis (BIA) can predict outcomes in critically ill patients requiring CRRT. Methods: A prospective observational study was performed in patients who were admitted to the intensive care unit and who required CRRT. BIA was conducted before CRRT; then, the ratio of extracellular water to total body water (ECW/TBW) was derived to estimate volume status. Results: A total of 31 patients treated with CRRT were included. There were 18 men (58.1%), and the median age was 67 years (interquartile range, 51 to 78 years). Fourteen patients (45.2%) died within 28 days after CRRT initiation. Patients were divided into 16 with ECW/TBW ≥0.41 and 15 with ECW/TBW <0.41. Survival rate within 28 days was different between the two groups (P = 0.044). Cox regression analysis revealed a relationship between ECW/TBW ≥0.41 and 28-day mortality, but it was not statistically significant (hazard ratio, 3.0; 95% confidence interval, 0.9 to 9.8; P = 0.061). Lastly, the area under the curve of ECW/TBW for 28-day mortality was analyzed. The area under the curve of ECW/TBW was 0.73 (95% confidence interval, 0.54 to 0.92), and this was significant (P = 0.037). Conclusions: Fluid status can be assessed using BIA in critically ill patients requiring CRRT, and BIA can predict mortality. Further large trials are needed to confirm the usefulness of BIA in critically ill patients.

Citations

Citations to this article as recorded by  
  • Nutritional management of children with acute kidney injury—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce
    Molly R. Wong Vega, Dana Cerminara, An Desloovere, Fabio Paglialonga, José Renken-Terhaerdt, Johan Vande Walle, Vanessa Shaw, Stella Stabouli, Caroline Elizabeth Anderson, Dieter Haffner, Christina L. Nelms, Nonnie Polderman, Leila Qizalbash, Jetta Tuokko
    Pediatric Nephrology.2023; 38(11): 3559.     CrossRef
  • Ratio of Overhydration and Extracellular Water Versus Ratio of Extracellular Water and Body Cell Mass in the Assessment of Fluid Status in Patients With Acute Kidney Injury Requiring Kidney Replacement Therapy: A Cohort Study
    Buyun Wu, Sufeng Zhang, Junfeng Wang, Wenyan Yan, Min Gao, Yifei Ge, Kang Liu, Xueqiang Xu, Xiangbao Yu, Yamei Zhu, Xianrong Xu, Changying Xing, Huijuan Mao
    Journal of Renal Nutrition.2022; 32(2): 152.     CrossRef
  • Towards Artefact-Free Bio-Impedance Measurements: Evaluation, Identification and Suppression of Artefacts at Multiple Frequencies
    Kanika Dheman, Philipp Mayer, Manuel Eggimann, Michele Magno, Simone Schuerle
    IEEE Sensors Journal.2022; 22(1): 589.     CrossRef
  • The Use of Bioelectrical Impedance Analysis Measures for Predicting Clinical Outcomes in Critically Ill Children
    Zi-Hong Xiong, Xue-Mei Zheng, Guo-Ying Zhang, Meng-Jun Wu, Yi Qu
    Frontiers in Nutrition.2022;[Epub]     CrossRef
  • Applying bio-impedance vector analysis (BIVA) to adjust ultrafiltration rate in critically ill patients on continuous renal replacement therapy: A randomized controlled trial
    Farin Rashid Farokhi, Effat Kalateh, Shadi Shafaghi, Antoine Guillaume Schneider, Seyed Mehdi Mortazavi, Hamidreza Jamaati, Seyed Mohammad Reza Hashemian
    Journal of Critical Care.2022; 72: 154146.     CrossRef
  • Ultrafiltration in critically ill patients treated with kidney replacement therapy
    Raghavan Murugan, Rinaldo Bellomo, Paul M. Palevsky, John A. Kellum
    Nature Reviews Nephrology.2021; 17(4): 262.     CrossRef
  • Kidney Replacement Therapy for Fluid Management
    Vikram Balakumar, Raghavan Murugan
    Critical Care Clinics.2021; 37(2): 433.     CrossRef
  • Assessment of Fluid Status by Bioimpedance Analysis and Central Venous Pressure Measurement and Their Association with the Outcomes of Severe Acute Kidney Injury
    Justina Karpavičiūtė, Inga Skarupskienė, Vilma Balčiuvienė, Rūta Vaičiūnienė, Edita Žiginskienė, Inga Arūnė Bumblytė
    Medicina.2021; 57(6): 518.     CrossRef
  • Usefulness of bioelectrical impedance analysis and ECW ratio as a guidance for fluid management in critically ill patients after operation
    Yoon Ji Chung, Eun Young Kim
    Scientific Reports.2021;[Epub]     CrossRef
  • Bioimpedance as a measure of fluid status in critically ill patients: A systematic review
    Janne M. Madsen, Sine Wichmann, Morten H. Bestle, Theis S. Itenov
    Acta Anaesthesiologica Scandinavica.2021; 65(9): 1155.     CrossRef
  • Bioelectric impedance analysis for body composition measurement and other potential clinical applications in critical illness
    Hanneke Pierre Franciscus Xaverius Moonen, Arthur Raymond Hubert Van Zanten
    Current Opinion in Critical Care.2021; 27(4): 344.     CrossRef
  • Hepatocyte growth factor and soluble cMet levels in plasma are prognostic biomarkers of mortality in patients with severe acute kidney injury
    Lilin Li, Jung Nam An, Jeonghwan Lee, Dong Jin Shin, Shi Mao Zhu, Jin Hyuk Kim, Dong Ki Kim, Dong-Ryeol Ryu, Sejoong Kim, Jung Pyo Lee
    Kidney Research and Clinical Practice.2021; 40(4): 596.     CrossRef
  • Wireless, Artefact Aware Impedance Sensor Node for Continuous Bio-Impedance Monitoring
    Kanika Dheman, Philipp Mayer, Michele Magno, Simone Schuerle
    IEEE Transactions on Biomedical Circuits and Systems.2020; 14(5): 1122.     CrossRef
  • Usefulness of Bioelectrical Impedance Analysis as a Guidance of Fluid Management in Critically Ill Patients after Major Abdomen Surgery; a Single Center, Prospective Cohort Study
    Yoon Ji Chung, Eun Young Kim
    Surgical Metabolism and Nutrition.2020; 11(2): 53.     CrossRef
  • Update on body composition tools in clinical settings: computed tomography, ultrasound, and bioimpedance applications for assessment and monitoring
    Kathleen L. Price, Carrie P. Earthman
    European Journal of Clinical Nutrition.2019; 73(2): 187.     CrossRef
  • Relative Association of Overhydration and Muscle Wasting with Mortality in Hemodialysis Patients: Assessment by Bioelectrical Impedance Analysis
    Eunju Kim, Sang Oh Seo, Yu Bum Choi, Mi Jung Lee, Jeong Eun Lee, Hyung Jong Kim
    The Korean Journal of Medicine.2018; 93(6): 548.     CrossRef
Case Reports
Vascular Surgery/Nephrology
Spontaneous Lumbar Artery Bleeding and Retroperitoneal Hematoma in a Patient Treated with Continuous Renal Replacement Therapy
Jin Kyung Park, Sung Ho Kim, Hee Jin Kim, Duk Hyun Lee
Korean J Crit Care Med. 2015;30(4):318-322.   Published online November 30, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.4.318
Correction in: Acute Crit Care 2016;31(1):71
  • 7,283 View
  • 88 Download
  • 2 Crossref
AbstractAbstract PDF
Rupture of the lumbar artery is usually associated with trauma but rarely has been reported in association with anticoagulation. We present a 71-year-old man who developed spontaneous rupture of the lumbar artery leading to a retroperitoneal hematoma while receiving continuous renal replacement therapy (CRRT). The bleeding was confirmed by computed tomography and angiography and was controlled successfully using selective angiographic embolization. We suggest that spontaneous retroperitoneal bleeding should be considered in a case of sudden decrease in hemoglobin in a CRRT patient.

Citations

Citations to this article as recorded by  
  • Transcatheter Arterial Embolization of Spontaneous Soft Tissue Hematomas: A Systematic Review
    Lahoud Touma, Sarah Cohen, Christophe Cassinotto, Caroline Reinhold, Alan Barkun, Vi Thuy Tran, Olivier Banon, David Valenti, Benoit Gallix, Anthony Dohan
    CardioVascular and Interventional Radiology.2019; 42(3): 335.     CrossRef
  • Three cases of spontaneous lumbar artery rupture in hemodialysis patients
    Na Kyoung Hwang, Harin Rhee, Il Young Kim, Eun Young Seong, Dong Won Lee, Soo Bong Lee, Ihm Soo Kwak, Chang Won Kim, Sang Heon Song
    Hemodialysis International.2017;[Epub]     CrossRef
Toxicology
Management of Cyanide Intoxication with Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy
Jin Park, Seung-Yeob Lee, Hyun-Sik Choi, Yoon Hee Choi, Young-Joo Lee
Korean J Crit Care Med. 2015;30(3):218-221.   Published online August 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.3.218
  • 7,558 View
  • 88 Download
  • 1 Crossref
AbstractAbstract PDF
Cyanide intoxication results in severe metabolic acidosis and catastrophic prognosis with conventional treatment. Indications of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) are expanding to poisoning cases. A 50-year-old male patient arrived in the emergency room due to mental change after ingestion of cyanide as a suicide attempt 30 minutes prior. He was comatose, and brain stem reflexes were absent. Initial laboratory analysis demonstrated severe metabolic acidosis with increased lactic acid of 25 mM/L. Shock and acidosis were not corrected despite a large amount of fluid resuscitation with high-dose norepinephrine and continuous renal replacement therapy. We decided to apply ECMO and CRRT to allow time for stabilization of hemodynamic status. After administration of antidote infusion, although the patient had the potential to progress to brain death status, vital signs were improved with correction of acidosis. We considered the evaluation for organ donation. We report a male patient who showed typical cyanide intoxication as lethal metabolic acidosis and cardiac impairment, and the patient recovered after antidote administration during vital organ support through ECMO and CRRT.

Citations

Citations to this article as recorded by  
  • Cyanogenic glycoside amygdalin influences functions of human osteoblasts in vitro
    Radoslav Omelka, Veronika Kovacova, Vladimira Mondockova, Birgit Grosskopf, Adriana Kolesarova, Monika Martiniakova
    Journal of Environmental Science and Health, Part B.2021; 56(2): 109.     CrossRef
Neurosurgery
Selection of Treatment for Large Non-Traumatic Subdural Hematoma Developed during Hemodialysis
Chul Hee Lee
Korean J Crit Care Med. 2014;29(2):114-118.   Published online May 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.2.114
  • 7,481 View
  • 72 Download
AbstractAbstract PDF
A 49-year-old man with end-stage renal disease was admitted to the hospital with a severe headache and vomiting. On neurological examination the Glasgow Coma Scale (GCS) score was 15 and his brain CT showed acute subdural hematoma over the right cerebral convexity with approximately 11-mm thickness and 9-mm midline shift. We chose a conservative treatment of scheduled neurological examination, anticonvulsant medication, serial brain CT scanning, and scheduled hemodialysis (three times per week) without using heparin. Ten days after admission, he complained of severe headache and a brain CT showed an increased amount of hemorrhage and midline shift. Emergency burr hole trephination and removal of the hematoma were performed, after which symptoms improved. However, nine days after the operation a sudden onset of general tonic-clonic seizure developed and a brain CT demonstrated an increased amount of subdural hematoma. Under the impression of persistent increased intracranial pressure, the patient was transferred to the intensive care unit (ICU) in order to control intracranial pressure. Management at the ICU consisted of regular intravenous mannitol infusion assisted with continuous renal replacement therapy. He stayed in the ICU for four days. Twenty days after the operation he was discharged without specific neurological deficits.
Successful Brain Dead Donor Management with CRRT: A Case Report
Sang Hyun Lim, Young Joo Lee, Han Bum Joe, Jae Moung Lee, In Kyung Lee
Korean J Crit Care Med. 2012;27(4):286-289.
DOI: https://doi.org/10.4266/kjccm.2012.27.4.286
  • 3,850 View
  • 56 Download
  • 1 Crossref
AbstractAbstract PDF
Brain death results in adverse pathophysiologic effects in many brain-dead donors with cardiovascular instability. We experienced a brain-dead donor with continuous renal replacement therapy (CRRT) who was in a severe metabolic, electrolyte derangement and poor pulmonary function. The thirty-nine-year-old male patient with subarachnoid hemorrhage and intraventricular hemorrhage was admitted into the intensive care unit (ICU). After sudden cardiac arrest, he went into a coma state and was referred to as a potential organ donor. When he was transferred, his vital sign was unstable even under the high dose of inotropics and vasopressors. Even with aggressive treatment, the level of blood sugar was 454 mg/dl, serum K+ 7.1 mEq/L, lactate 5.33 mmol/L and PaO2/FiO2 60.3. We decided to start CRRT with the mode of continuous venovenous hemodiafiltration (CVVHDF). After 12 hours of CRRT, vital sign was maintained well without vasopressors, and blood sugar, serum potassium and lactate levels returned to 195 of PaO2/FiO2. Therefore, he was able to donate his two kidneys and his liver.

Citations

Citations to this article as recorded by  
  • Activation Policy for Brain-dead Organ Donation
    Young-Joo Lee
    The Ewha Medical Journal.2015; 38(1): 1.     CrossRef
Original Articles
Initiation of Continuous Renal Replacement Therapy and Clinical Outcome in Septic Shock Patients with Acute Kidney Injury
Seung Mok Ryoo, Won Young Kim, Sang Sik Choi, Jin Won Huh, Sang Bum Hong, Chae Man Lim, Younsuck Koh
Korean J Crit Care Med. 2012;27(1):29-35.
DOI: https://doi.org/10.4266/kjccm.2012.27.1.29
  • 2,506 View
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AbstractAbstract PDF
BACKGROUND
Initiation of renal replacement therapy (RRT) in critically ill septic shock patients with acute kidney injury is highly subjective and may influence outcome. The aim of this study is to evaluate the relationship between initiation of RRT and 28 day mortality in patients with severe sepsis and septic shock (SSSS).
METHODS
All patients diagnosed with SSSS and treated at the medical intensive care unit (ICU) in university-affiliated hospital from January 2005 to December 2006 were reviewed. Initiation of RRT was stratified into "early" and "late" by RIFLE (Risk, Injury, Failure, Loss, and End-stage) criteria and blood urea nitrogen (BUN) at the time RRT began. The primary outcome was death after 28 days from any cause.
RESULTS
Of the 326 patients diagnosed with SSSS and admitted into the medical ICU during the study period, 78 patients received RRT. Mean age was 61.5 +/- 14.7 years old and 54 patients were male (69.2%). The initiation of RRT was categorized into early (Risk, and Injury) and late (Failure) by RIFLE criteria and also categorized into early (BUN < 75 mg/dl) and late (BUN > or = 75 mg/dl). When the relationship between RIFLE criteria and 28 day mortality was compared, no significant difference was shown (70.8% vs. 73.3%, p = 0.81). The initiation of RRT by BUN also showed no significant difference in 28 day mortality (77.3% vs. 69.6%, p = 0.50).
CONCLUSIONS
Initiation of RRT, stratified into "early" and "late" by RIFLE and BUN, showed no significant difference in 28 day mortality regarding patient with SSSS.
Predictors of Mortality and Complication in Pediatric Patients Who Require Continuous Renal Replacement Therapy in Pediatric Intensive Care Unit
Jae Wook Choi, Woo Jin Chung, Young Joo Han, Ju Kyung Lee, Dong In Suh, June Dong Park, Young Yull Koh
Korean J Crit Care Med. 2011;26(3):171-176.
DOI: https://doi.org/10.4266/kjccm.2011.26.3.171
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  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
The objective of this study is to analyze the factors associated with mortality and complication in children requiring continuous renal replacement therapy (CRRT) in a pediatric intensive care unit.
METHODS
We retrospectively analyzed 96 patients who required CRRT at a pediatric intensive care unit in Seoul National University Hospital between April 2005 and April 2011. We evaluated the clinical features, diagnosis, mortality risk factors and complications related to CRRT.
RESULTS
Univariate and multivariate analyses were performed to analyze the mortality risk factors of patients requiring CRRT. The overall mortality was 56.3%, the median age was 8 years, and the ages ranged from 4 days to 22 years. The median weight of the patients was 7.9 kg, and the weights ranged from 3.6-72.9 kg. 16 patients were diagnosed with primary renal disease, and the remainder with other underlying diseases. Mortality was higher in children who received stem cell transplantation and in children with a diagnosis of imunologic disease and neurologic disease. The Pediatric Risk of Mortality (PRISM) III score at initiating CRRT was 17.8 +/- 8.9 and the degree of fluid overload at CRRT (FO%) was 12.9 +/- 16.0. The PRISM III score at the start of CRRT and low uric acid level were the factors associated with an increased risk of mortality. Of the 96 children, 13 (13.53%) presented problems of venous catheterization. Hypotension during connection to CRRT was detected in 28 patients (29.2%). Clinically significant hemorrhage occurred in 10 patients (10.4%).
CONCLUSIONS
Children who require CRRT have a high mortality rate. The higher score of PRISM III at the starting time of CRRT and the lower uric acid level are the factors associated with a higher mortality. The most frequent complication of CRRT was hypotension on connection to CRRT.

Citations

Citations to this article as recorded by  
  • Continuous Renal Replacement Therapy in the Neonatal Intensive Care Unit: A Single-Center Study
    Moon-yeon Oh, Byong Sop Lee, Seong-Hee Oh, Hee Jin Jang, Hyun-Jeong Do, Ellen Ai-Rhan Kim, Ki-Soo Kim, Joo Hoon Lee, Young Seo Park, Beom-Hee Lee, Han-Wook Yoo
    Neonatal Medicine.2014; 21(4): 244.     CrossRef

ACC : Acute and Critical Care