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

  • Guntulu SıkEmail author
  • Asuman Demirbuga
  • Seda Günhar
  • Kemal Nisli
  • Agop Citak
Original Article



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.


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.


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.


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.


Continuous renal replacement therapy Pediatric intensive care Hemofiltration Hemodiafiltration 



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.

Compliance with Ethical Standards

Conflict of Interest


Source of Funding


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.

Informed Consent

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


  1. 1.
    Symons JM, Chua AN, Somers MJ, et al. Demographic characteristics of pediatric continuous renal replacement therapy: a report of the prospective pediatric continuous renal replacement therapy registry. Clin J Am Soc Nephrol. 2007;2:732–8.PubMedGoogle Scholar
  2. 2.
    Boschee ED, Cave DA, Garros D, et al. Indications and outcomes in children receiving renal replacement therapy in pediatric intensive care. J Crit Care. 2014;29:37–42.PubMedGoogle Scholar
  3. 3.
    Lowrie LH. Renal replacement therapies in pediatric multiorgan dysfunction syndrome. Pediatr Nephrol. 2000;14:6–12.PubMedGoogle Scholar
  4. 4.
    Goldstein SL, Somers MJ, Baum MA, et al. Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int. 2005;67:653–8.PubMedGoogle Scholar
  5. 5.
    Foland JA, Fortenberry JD, Warshaw BL, et al. Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis. Crit Care Med. 2004;32:1771–6.PubMedGoogle Scholar
  6. 6.
    Goldstein SL, Currier H, Graf C, Cosio CC, Brewer ED, Sachdeva R. Outcome in children receiving continuous venovenous hemofiltration. Pediatrics. 2001;107:1309–12.PubMedGoogle Scholar
  7. 7.
    Kellum JA, Lameire N. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary. On behalf of the KDIGO guideline AKI group. Crit Care. 2013;17:204.PubMedGoogle Scholar
  8. 8.
    Kwiatkowski DM, Krawczeski CD. Acute kidney injury and fluid overload in infants and children after cardiac surgery. Pediatr Nephrol. 2017;32:1509–17.PubMedGoogle Scholar
  9. 9.
    Al-Ayed T, Siddiqui NR, Alturki A, Aljofan F. Outcome of continuous renal replacement therapy in critically ill children: a retrospective cohort study. Ann Saudi Med. 2018;38:260–8.PubMedGoogle Scholar
  10. 10.
    Yetimakman AF, Kesici S, Tanyildiz M, Bayrakci US, Bayrakci B. A report of 7-year experience on pediatric continuous renal replacement therapy. J Intensive Care Med. 2017.
  11. 11.
    Hayes LW, Oster RA, Tofil NM, Tolwani AJ. Outcomes of critically ill children requiring continuous renal replacement therapy. J Crit Care. 2009;24:394–400.PubMedGoogle Scholar
  12. 12.
    Bagshaw SM, Uchino S, Bellomo R, et al. Beginning and ending supportive therapy for the kidney (BEST kidney) investigators. Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury. J Crit Care. 2009;24:129–40.PubMedGoogle Scholar
  13. 13.
    Sutherlan SM, Zappitelli M, Alexander SR, et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis. 2010;55:316–25.Google Scholar
  14. 14.
    Gillespie RS, Seidel K, Symons JM. Effect of fluid overload and dose of replacement fluid on survival in hemofiltration. Pediatr Nephrol. 2004;19:1394–9.PubMedGoogle Scholar
  15. 15.
    Mitchell JP, Schuller D, Calandrino FS, Schuster DP. Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization. Am Rev Respir Dis. 1992;145:990–8.PubMedGoogle Scholar
  16. 16.
    Choi SJ, Ha E-J, Jhang WK, Park SJ. Factors associated with mortality in continuous renal replacement therapy for pediatric patients with acute kidney ınjury. Pediatr Crit Care Med. 2017;18:e56–61.PubMedGoogle Scholar
  17. 17.
    Modem V, Thompson M, Gollhofer D, Dhar AV, Quigley R. Timing of continuous renal replacement therapy and mortality in critically ill children. Crit Care Med. 2014;42:943–53.PubMedGoogle Scholar
  18. 18.
    Arikan AA, Zappitelli M, Goldstein SL, Naipaul A, Jefferson LS, Loftis LL. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. Pediatr Crit Care Med. 2012;13:253–8.PubMedGoogle Scholar
  19. 19.
    Sanchez-de-Toledo J, Perez-Ortiz A, Gil L, et al. Early initiation of renal replacement therapy in pediatric heart surgery ıs associated with lower mortality. Pediatr Cardiol. 2016;37:623–8.PubMedGoogle Scholar
  20. 20.
    Upadya A, Tilluckdharry L, Muralidharan V, Amoateng-Adjepong Y, Manthous CA. Fluid balance and weaning outcomes. Intensive Care Med. 2005;31:1643–7.PubMedGoogle Scholar
  21. 21.
    Valentine SL. Sapru a, Higgerson RA, et al; pediatric acute lung injury and Sepsis Investigator's (PALISI) network; acute respiratory distress syndrome clinical research network (ARDSNet). Fluid balance in critically ill children with acute lung injury. Crit Care Med. 2012;40:2883–9.PubMedGoogle Scholar
  22. 22.
    Hazle MA, Gajarski RJ, Yu S, Donohue J, Blatt NB. Fluid overload in infants following congenital heart surgery. Pediatr Crit Care Med. 2013;14:44–9.PubMedGoogle Scholar
  23. 23.
    Rustagi RS, Arora K, Das RR, Pooni PA, Singh D. Incidence, risk factors and outcome of acute kidney injury in critically ill children - a developing country perspective. Paediatr Int Child Health. 2017;37:35–41.PubMedGoogle Scholar
  24. 24.
    Lai TS, Shiao CC, Wang JJ, et al. Earlier versus later initiation of renal replacement therapy among critically ill patients with acute kidney injury: a systematic review and meta-analysis of randomized controlled trials. Ann Intensive Care. 2017;7:38.PubMedGoogle Scholar
  25. 25.
    Karvellas CJ, Farhat MR, Sajjad I, et al. A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis. Crit Care. 2011;15:R 72.Google Scholar
  26. 26.
    Gulla KM, Sachdev A, Gupta D, Gupta N, Anand K, Pruthi PK. Continuous renal replacement therapy in children with severe sepsis and multiorgan dysfunction - a pilot study on timing of initiation. Indian J Crit Care Med. 2015;19:613–7.PubMedGoogle Scholar
  27. 27.
    Bellomo R, Cass A, Cole L, et al; Renal Replacement Therapy Study Investigators. An observational study fluid balance and patient outcomes in the randomized evaluation of normal vs augmented level of replacement therapy trial. Crit Care Med. 2012;40:1753–60.PubMedGoogle Scholar
  28. 28.
    Selewski DT, Cornell TT, Blatt NB, et al. Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy. Crit Care Med. 2012;40:2694–9.PubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2019

Authors and Affiliations

  1. 1.Pediatric Intensive Care UnitAcıbadem Mehmet Ali Aydınlar University School of MedicineIstanbulTurkey
  2. 2.Department of PediatricsIstanbul University School of MedicineIstanbulTurkey

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