Prolonged intermittent renal replacement therapy in children

  • Rajiv Sinha
  • Sidharth Kumar Sethi
  • Timothy Bunchman
  • Valentine Lobo
  • Rupesh Raina


Wide ranges of age and weight in pediatric patients makes renal replacement therapy (RRT) in acute kidney injury (AKI) challenging, particularly in the pediatric intensive care unit (PICU), wherein children are often hemodynamically unstable. Standard hemodialysis (HD) is difficult in this group of children and continuous veno-venous hemofiltration/dialysis (CVVH/D) has been the accepted modality in the developed world. Unfortunately, due to cost constraints, CVVH/D is often not available and peritoneal dialysis (PD) remains the common mode of RRT in resource-poor facilities. Acute PD has its drawbacks, and intermittent HD (IHD) done slowly over a prolonged period has been explored as an alternative. Various modes of slow sustained IHD have been described in the literature with the recently introduced term prolonged intermittent RRT (PIRRT) serving as an umbrella terminology for all of these modes. PIRRT has been widely accepted in adults with studies showing it to be as effective as CVVH/D but with an added advantage of being more cost-effective. Pediatric data, though scanty, has been promising. In this current review, we elaborate on the practical aspects of undertaking PIRRT in children as well as summarize its current status.


SLED Dialysis Sustained low efficiency dialysis PIRRT Prolonged intermittent renal replacement therapy PICU 



The authors wish to acknowledge Jennifer L. Clark, Grant/Medical Writer at Rebecca D. Considine Clinical Research Institute, Akron Children Hospital and Dr. Vinod Krishappa research fellow at Akron General Hospital, Cleveland Clinic Foundation, Akron, Ohio.

Compliance with ethical standards

Funding/ support


Competing interests

Dr. Timothy Bunchman has served as consultant to Baxter. The rest of the authors do not have any relevant competing interests to disclose.


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Copyright information

© IPNA 2017

Authors and Affiliations

  • Rajiv Sinha
    • 1
  • Sidharth Kumar Sethi
    • 2
  • Timothy Bunchman
    • 3
  • Valentine Lobo
    • 4
  • Rupesh Raina
    • 5
  1. 1.Institute of Child Health and AMRI HospitalKolkataIndia
  2. 2.Pediatric Nephrology, Kidney InstituteMedanta, The MedicityGurgaonIndia
  3. 3.Pediatric NephrologyChildren’s Hospital of Richmond at VCURichmondUSA
  4. 4.Department of NephrologyKEM HospitalPuneIndia
  5. 5.Pediatric NephrologyAkron Children’s HospitalClevelandUSA

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