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Controversies in paediatric continuous renal replacement therapy

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Abstract

Background

Continuous renal replacement therapy (CRRT) is an invaluable means of supporting critically ill children with many illnesses, including acute renal failure, drug intoxication, inborn errors of metabolism, and multiorgan failure. However, the ideal method of applying the technique is unknown.

Discussion

The indications for initiation of CRRT, mode, dose, and means of anticoagulating the circuit to prolong filter life are all subjects of controversy. The formation of a prospective, multicentre paediatric CRRT registry has been a major step forward but large, randomised trials of the sort that exist in adult medicine are lacking. This review describes the basic technique of CRRT, highlights the differences between adult and paediatric prescription, and elaborates on the main controversies in the application of CRRT in children.

Conclusions

Current evidence suggests that early initiation of CRRT before the onset of substantial fluid overload, considering continuous haemofiltration in disease states such as respiratory failure following stem cell transplantation, and the use of continuous haemodialysis and citrate anticoagulation to prolong circuit life may be associated with improved outcomes.

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Authors and Affiliations

  1. Departments of Paediatrics and Cardiac Surgery, National University Health System, Singapore, Singapore

    Graeme MacLaren

  2. Intensive Care Unit, The Royal Children’s Hospital, Melbourne, Australia

    Graeme MacLaren & Warwick Butt

  3. Department of Paediatrics, The University of Melbourne, Melbourne, Australia

    Warwick Butt

  4. Cardiothoracic Intensive Care Unit, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore

    Graeme MacLaren

Authors
  1. Graeme MacLaren
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  2. Warwick Butt
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Correspondence to Graeme MacLaren.

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MacLaren, G., Butt, W. Controversies in paediatric continuous renal replacement therapy. Intensive Care Med 35, 596–602 (2009). https://doi.org/10.1007/s00134-009-1425-4

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