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CRRT in a Child in Cardiac ICU

  • Cristiana Garisto
  • Zaccaria Ricci
Chapter

Abstract

Acute kidney injury (AKI) in children with congenital heart disease is a serious condition with an important impact on morbidity and mortality. Several risk factors should be considered in this peculiar group of critically ill children. Among the most important, perioperative renal injury due to cardiopulmonary bypass and the influence of surgery and pharmacologic management in restoring normal hemodynamics have to be kept in mind. Effective treatments are not currently available for established AKI in cardiac surgery patients and, even if specific indications have to be considered for each different case, generally, early renal replacement therapy initiation is recommended.

Epidemiology and outcome of acute pediatric dialysis will be reviewed. Continuous renal replacement therapy (CRRT) and peritoneal dialysis (PD) are the preferred forms of dialysis delivery in critically ill children for the treatment of severe acute kidney injury (AKI). The latter is currently considered the gold standard treatment for severe AKI in neonates with congenital heart diseases.

Outcomes are significantly associated with age, the presence of hypotension and other hemodynamic derangements (i.e., right ventricular failure and elevated central venous pressure) and the amount of fluid overload accumulated by children before the CRRT initiation. Timing and dose of pediatric CRRT are to be further evaluated in prospective trials even if a child with congenital heart disease has to be always considered as a cardiorenal syndrome subject: in this context, severe worsening of renal function is likely triggering a proactive and effective treatment with renal replacement. A final aspect worth of review is the technical issue: accuracy of new generation of CRRT monitors and novel dedicated circuits have been developed. In the future years, delivery and outcome of pediatric CRRT are expected to significantly improve with the target of extending and anticipating dialysis start in critically ill children with congenital heart diseases.

Keywords

Congenital heart disease Cardiopulmonary bypass Peritoneal dialysis Hemofiltration Hemodialysis Fluid overload 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Cardiology and Cardiac SurgeryPediatric Cardiac Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCSRomeItaly

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