Continuous renal replacement therapies for children with acute renal failure and metabolic disorders

  • M. Gregory
  • T. E. Bunchman
  • P. D. Brophy


Conceptually, the basic application principles of continuous renal replacement therapy (CRRT) are similar for adults and children. However, applying these modalities in children requires recognition of the unique properties of pediatric CRRT. The pediatric patient requires specific consideration of several factors. These include, but are not limited to nutritional factors, different disease processes not commonly seen in the adult patient (e.g. inborn errors of metabolism), vascular access, membranes, machine choice and extracorporeal blood volume/blood priming (especially in patients <10 kg)1.


Peritoneal Dialysis Continuous Renal Replacement Therapy Blood Flow Rate Maple Syrup Urine Disease Pediatric Dialysis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Smoyer WE, Maxvold NJ, Remenapp R, Bunchman TE. Pediatric renal replacement therapy In: Fuhrman BP, Zimmerman JJ, editors. Pediatric Critical Care, 2nd edn. St. Louis, MO: Mosby, 1998: Chap. 64, pp. 764–78.Google Scholar
  2. 2.
    Ronco C, Brendolan A, Dan M, Piccinni P, Bellomo R. Machines for continuous renal replacement therapy. In: Ronco C, Bellomo R, La Greca, editors. Blood Purification in Intensive Care (Contributions to Nephrology V 132-Berlyne GM. And Ronco C.) New York: Karger, 2001: pp. 323–34.Google Scholar
  3. 3.
    Warady B, Bunchman T. Dialysis therapy for children with acute renal failure: survey results. Pediatr Nephrol 2000;15:11–13.PubMedCrossRefGoogle Scholar
  4. 4.
    Ponikvar R, Kandus A, Urbancic A, Kornhauser AG, Primozic J, Ponikvar JB. Continuous renal replacement therapy and plasma exchange in newborns and infants. Artif Organs. 2002;26:163–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Parekh RS, Bunchman TE. Dialysis support in the pediatric intensive care unit. Adv Renal Replace Ther. 1996;3(4):326–36.Google Scholar
  6. 6.
    Silvester W, Bellomo R, Cole L. Epidemiology, management, and outcome of severe acute renal failure of critical illness in Australia. Crit Care Med. 2001;29:1910–15.PubMedCrossRefGoogle Scholar
  7. 7.
    Goldstein S, Currier H, Graf J, Cosio CC, Brewer ED, Sachdeva R. Outcome in children receiving continuous venovenous hemofiltration. Pediatrics. 2001;107(6): 1309–12.PubMedCrossRefGoogle Scholar
  8. 8.
    Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinii P, La Greca G. Efects of different doses in continuous veno-venous hemofiltration on outcomes of acute renal failure: a prospective randomized trial. Lancet. 2000;356:26–30.PubMedCrossRefGoogle Scholar
  9. 9.
    Burchardi H. Renal Replacement (RRT) in the ICU: criteria for initiating RRT. In: Ronco C, Bellomo R, La Greca editors. Blood Purification in Intensive Care (Contributions to Nephrology V 132-Berlyne GM and Ronco C) New York: Karger, 2001: pp. 171–80.Google Scholar
  10. 10.
    Meyer MM. Renal replacement therapies. Crit Care Clin. 2000;16 (l):29–58.PubMedCrossRefGoogle Scholar
  11. 11.
    Schuerer DJ, Brophy PD, Maxvold NJ, Kudelka T, Bunchman TE. High-efficiency dialysis for Carbamazepine overdose. J Toxicol Clin Toxicol. 2000;38(3):321–3.PubMedCrossRefGoogle Scholar
  12. 12.
    Kox WJ, Rohr U, Wauer H. Practical aspects of renal replacement therapy. Int J Artif Organs. 1996;19:100–5.PubMedGoogle Scholar
  13. 13.
    Ronco C, Bellomo R. Basic mechanisms and definitions for continuous renal replacement therapies. Int J Artif Organs. 1996;19:95–9.PubMedGoogle Scholar
  14. 14.
    Brunet S, Leblanc M, Geadah D, Parent D, Courteau S, Cardinal J. Diffusive and convective solute clearances during continuous renal replacement therapy at various dialysate and ultrafiltration flow rates. Am J Kidney Dis. 1999;34:486–92.PubMedCrossRefGoogle Scholar
  15. 15.
    Leone MR, Jenkins RD, Golper TA, Alexander SR. Early Experience with Continuous Arteriovenous hemofiltration in Critically ill Pediatric Patients. Crit Care Med. 1986;14:1058–63.PubMedCrossRefGoogle Scholar
  16. 16.
    Barletta GM, Kershaw DB, Mottes TA, McBryde KD, Bunchman TE, Brophy PD. Intraoperative continuous renal replacement therapy in pediatric intensive care unit patients. J Am Soc Nephrol. 2003;14:731 A (abstract).Google Scholar
  17. 17.
    Baldwin I. Keeping pace with changes in technology and technique. Blood Purif. 2002;20:268–74.CrossRefGoogle Scholar
  18. 18.
    Bunchman TE, Maxvold NJ, Barnett J, Hutchings A, Benfield MR. Pediatric hemofiltration: Normocarb® dialysate solution with citrate anticoagulation. Pediatr Nephrol. 2002;17:150–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Laliberte-Murphy K, Palsson R, Niles JL. Continuous venovenous hemofiltration (CVVH)-alternative methods for delivering CVVH in a high-risk pediatric liver transplant recipient-Case report 2001. Blood Purif. 2001;19:344 (abstract).Google Scholar
  20. 20.
    Clark WR, Ronco C. CRRT efficiency and efficacy in relation to solute size. Kidney Int. 2000;56(Suppl 72):S3–7.Google Scholar
  21. 21.
    Werner HA, Herbertson MJ, Seear MD. Functional characteristics of pediatric veno-venous hemofiltration. Crit Care Med. 1994;22:320–25.PubMedCrossRefGoogle Scholar
  22. 22.
    Jenkins RD, Kuhn RJ, Funk JE. Clinical implications of catheter variability on neonatal continuous arteriovenous hemofiltration. ASAIO Trans. 1998;34:108–11.CrossRefGoogle Scholar
  23. 23.
    Bunchman T, McBryde K, Mottes T, Gardner JJ, Maxvold NJ, Brophy PD. Pediatric acute renal failure: outcome by modality and disease. Pediatr Nephrol. 2001;16:1067–71.PubMedCrossRefGoogle Scholar
  24. 24.
    Barenbrock M, Hausberg M, Matzkies F, de la Motte S, Schaefer RM. Effects of bicarbonate-and lactate-buffered replacement fluids on cardiovascular outcome in CVVH patients. Kidney Int. 2000;58(4):1751–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Mehta RL, McDonald BR, Aguilar MM, Ward DM. Regional citrate anticoagulation for continuous arteriovenous hemodialysis in critically ill patients. Kidney Int. 1990;38:976–81.PubMedCrossRefGoogle Scholar
  26. 26.
    Tolwani A, Campbell R, Schenk M, Allon M, Warnock DG. Simplified citrate anticoagulation for continuous renal replacement therapy. Kidney Int. 2001;60:370–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Geary DF, Gajaria M, Fryer-Keene S, Willumsen J. Low-dose and heparin-free hemodialysis in children. Pediatr Nephrol. 1991;5:220–224.PubMedCrossRefGoogle Scholar
  28. 28.
    Chadha V, Garg U, Warady BA, Alon US. Citrate clearance in children receiving continuous venovenous renal replacement therapy. Pediatr Nephrol. 2002;19:810–24.Google Scholar
  29. 29.
    Benner K, Barnett J, Maxvold N, Rhodes R, Bunchman T. Normocarb/citrate vs pharmacy made dialysate/heparin: Cost, time and liability. Pediatr Nephrol. 2002;17:C149 (abstract).Google Scholar
  30. 30.
    Kellum JA, Mehta RL, Ronco C. Acute Dialysis Quality Initiative (ADQI). In: Ronco C, Bellomo R., and La Greca, (editors). Blood Purification in Intensive Care (Contributions to Nephrology V 132-Berlyne GM and Ronco C) New York: Karger, 2001: pp. 258–65.Google Scholar
  31. 31.
    Himmelfarb J, Tolkoff Rubin N, Chandran P, Parker RA, Wingard RL, Hakim RA. multicenter comparison of dialysis membranes in the treatment of acute renal failure requiring dialysis. J Am Soc Nephrol 1998;9:257–66.PubMedGoogle Scholar
  32. 32.
    Tournier O, Delaunay M. The AN-69 dialysis membrane. Hospital Product Pamphlet. 1995:1–36.Google Scholar
  33. 33.
    Renaux JL, Thomas M. Hypersensitivity reactions and dialysis membranes. Hospital Product Pamphlet. 1996:1–19.Google Scholar
  34. 34.
    Lacour F, Maheut H. AN 69 membrane and conversion enzyme inhibitors: prevention of anaphylactic shock by alkaline rinsing? Nephrologie. 1992;13(3):135–6.PubMedGoogle Scholar
  35. 35.
    Bartlett RH, Mault JR, Dechert RE, Palmer J, Swartz RD, Port FK. Continuous arteriovenous hemofiltration: improved survival in surgical acute renal failure? Surgery. 1986;100(2):400–8.PubMedGoogle Scholar
  36. 36.
    Davies SP, Reaveley DA, Brown EA, Kox WJ. Amino acid clearance and daily losses in patients with acute renal failure treated by continuous arteriovenous hemofiltration In: Kramer P, editor. Arteriovenous Hemofiltration. Berlin: Springer-Verlag, 1985: pp. 139–51.Google Scholar
  37. 37.
    Davenport A, Roberts NB: Amino acid losses during continuous high-flux hemofiltration in the critically ill patient. Crit Care Med. 1989;17:1010–14.PubMedCrossRefGoogle Scholar
  38. 38.
    Mokrzycki MH, Kaplan AA: Protein losses in continuous renal replacement therapies. J Am Soc Nephrol. 1996;7:2259–63.PubMedGoogle Scholar
  39. 39.
    Maxvold NJ, Smoyer WE, Custer JR, Bunchman TE. Amino acid loss and nitrogen balance in critically ill children with acute renal failure: A prospective comparison between classic hemofiltration and hemofiltration with dialysis. Crit Care Med. 2000;28:1161–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Bellomo R, Tan HK, Bhonagiri S, Gopal I, Seacombe J, Daskalakis M, Boyce N. High protein intake during continuous hemodiafiltration: impact on amino acids and nitrogen balance. Int J Artif Organs. 2002;25(4):263–8.Google Scholar
  41. 41.
    Payne-Jams JJ, Grimble GK. Present status of glutamine. Curr Opin Gastroenterol. 1995;11:161–7.CrossRefGoogle Scholar
  42. 42.
    Wilmore DW. Alterations in protein, carbohydrate and fat metabolism in injured and septic patients. J Am Coll Nutr. 1983;2:3–13.PubMedGoogle Scholar
  43. 43.
    Georgieff M, Tvgtekin IF. Positive role of immune nutrition on metabolism in sepsis and multi-organ failure. Kidney Int. 1998;53(Suppl):S80–3.Google Scholar
  44. 44.
    Pastores SM, Kvetan V, Katz DP. Immunomodulatory effects and therapeutic potential of glutamine in the critically ill surgical patient. Nutrition. 1994;10:385–91.PubMedGoogle Scholar
  45. 45.
    Lowrie, L. Renal replacement therapies in pediatric multi-organ dysfunction syndrome. Pediatr Nephrol. 2000;14:6–12.PubMedCrossRefGoogle Scholar
  46. 46.
    Andreoli SP. Acute renal failure. Curr Opin Pediatr. 2002;14(2): 183–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Wong W, McCall E, Anderson B, Segedin E, Morris M. Acute Renal failure in the pediatric intensive care unit. N Zeal Med J. 1996;109:450–61.Google Scholar
  48. 48.
    Mogal NE, Brocklebank JT, Meadow SR. A review of acute renal failure in children: incidence, etiology and outcome. Clin Nephrol. 1998;49:91–95.Google Scholar
  49. 49.
    Smoyer WE, McAdams C, Kaplan BS, Sherbotie JR. Determinants of survival in pediatric continuous hemofiltration. J Am Soc Nephrol. 1995;6:1401–9.PubMedGoogle Scholar
  50. 50.
    Symons JM, Brophy PD, Gregory MJ et al. Continuous renal replacement therapy in children up to 10 kg. Am J Kidney Dis. 2003;41(5):984–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Puliyanda DP, Harmon WE, Peterschmitt MJ, Irons M, Somers MJG. Utility of hemodialysis in Maple Syrup Urine disease. Pediatr Nephrol. 2002;17:239–42.PubMedCrossRefGoogle Scholar
  52. 52.
    Jouvet P, Jugie M, Rabier D, Desgres J, Hubert P, Saudubray JM, Man NK. Combined nutritional support and continuous extracorporeal removal therapy in the severe acute phase of Maple Syrup Urine disease. Int Care Med. 2001;27:1798–806.CrossRefGoogle Scholar
  53. 53.
    Thompson GN, Butt WW, Shann FA, Kirby DM, Henning RD, Howells DW, Osborne A. Continuous venovenous hemofiltration in the management of acute decompensation in inborn errors of metabolism. J Pediatr. 1991;118:879–84.PubMedCrossRefGoogle Scholar
  54. 54.
    McBryde KD, Smoyer WB, Kershaw DB, Kudelka TL, Gardner JJ, Brophy PD. Clearance of the branched chain amino acids in neonatal hemodialysis. J Am Soc Nephrol. 2002;1313 (9):709A.Google Scholar
  55. 55.
    McBryde KD, Brophy PD, Gregory MJ, Maxvold NJ, Gardner JJ, Mottes TA, Bunchman TE. Renal replacement therapy in metabolic disturbances. J Am Soc Nephrol. 2001;12(9): 175A.Google Scholar
  56. 56.
    McBryde KD, Kershaw DB, Kudelka TL, Smoyer WE, Gardner JJ, Brophy PD. Hemodialysis clearance of glutamine and glycine in argininosuccinate synthetase deficiency. J Am Soc Nephrol. 2002;13(9):416A.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2004

Authors and Affiliations

  • M. Gregory
  • T. E. Bunchman
  • P. D. Brophy

There are no affiliations available

Personalised recommendations