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Clinical Features and Indications Associated with Mortality in Continuous Renal Replacement Therapy for Pediatric Patients

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Abstract

Objectives

To identify prognostic factors and indications in patients receiving continuous renal replacement therapy (CRRT) in the pediatric intensive care unit (PICU), and to demonstrate their effect on mortality.

Methods

A total of 63 patients admitted between 2011 and 2014 were included in the study. The demographic information, pediatric risk of mortality (PRISM) scores, vasoactive-inotropic score, indication for CRRT, time of starting CRRT, presence of fluid overload, durations of CRRT, and pediatric intensive care unit (PICU) stay were compared between survivors and non-survivors.

Results

The overall rate of survival was 69,8%. The most common indication for CRRT was fluid overload (31.7%) followed by acute attacks of metabolic diseases (15.9%), and resistant metabolic acidosis (15.9%). The median duration of CRRT was 58 (IQR 24–96) h. The most common CRRT modality was continuous venovenous hemodiafiltration. The CRRT modality was not different between survivors and nonsurvivors. Sepsis, as the diagnosis for admission to intensive care unit was significantly related to decreased survival when compared to acute kidney injury and acute attacks of metabolic diseases. Patients with fluid overload had significantly increased rate of death, CRRT duration, use of mechanical ventilation, and PICU stay.

Conclusions

The CRRT, can be effectively used for removal of fluid overload, treatment of acute attacks of metabolic diseases, and other indications in critically ill pediatric patients. It has a positive effect on mortality in high-risk PICU patients. This treatment modality can be used more frequently in pediatric intensive care unit with improved patient outcomes, and should be focused on starting therapy in early stages of fluid overload.

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Contributions

GŞ, AD, SG: Collection of cases and treatment of patients; KN, AC: Writing of the study and statistical evaluation. AC will act as guarantor for this paper.

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Authors and Affiliations

  1. Pediatric Intensive Care Unit, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey

    Guntulu Sık, Asuman Demirbuga & Agop Citak

  2. Department of Pediatrics, Istanbul University School of Medicine, Istanbul, Turkey

    Seda Günhar & Kemal Nisli

Authors
  1. Guntulu Sık
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  2. Asuman Demirbuga
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  3. Seda Günhar
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  4. Kemal Nisli
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  5. Agop Citak
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Correspondence to Guntulu Sık.

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Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed concent was obtained from the parents of all children included in the study.

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Sık, G., Demirbuga, A., Günhar, S. et al. Clinical Features and Indications Associated with Mortality in Continuous Renal Replacement Therapy for Pediatric Patients. Indian J Pediatr 86, 360–364 (2019). https://doi.org/10.1007/s12098-019-02868-w

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  • DOI: https://doi.org/10.1007/s12098-019-02868-w

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