Abstract
During the past 20 years, childhood renal replacement therapy (RRT) and the treatment of underlying diseases experienced extensive advances. We reviewed the data of our critically ill patients with acute renal failure (ARF) and RRT, comparing two decades from 1985 to 1994 and from 1995 to 2004. There were 87 patients with a mortality rate of 45% in the first decade, decreasing to 28 patients with a mortality rate of 39% in the second decade. The mortality rate decreased from 51% to 20% in patients older than one year, while the mortality rate in patients younger than one year increased from 38% to 88%. Yet, the absolute number of these non-survivors younger than one year decreased from 16 to seven patients. The decrease of RRT was mainly caused by a decrease of ARF secondary to heart surgery, oncologic disorders and sepsis. Whereas the majority of patients (75%) were treated with continuous haemofiltration in the first decade, 75% of patients were treated with continuous haemodiafiltration in the second decade.In conclusion, advances in the diagnosis and treatment of underlying disorders have reduced the need for RRT in critically ill paediatric patients during the past 20 years. In addition, there was a tendency for a decrease in the overall mortality, which might be caused by changing treatment policies and advances in RRT technology. Nevertheless, the high mortality rate in small infants is challenging.
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Abbreviations
- RRT:
-
Renal replacement therapy
- ARF:
-
Acute renal failure
- CAVH:
-
Continuous arterio-venous haemofiltration
- CVVH:
-
Continuous veno-venous haemofiltration
- CVVHDF:
-
Continuous veno-venous haemodiafiltration
- SCU:
-
Slow continuous ultrafiltration
- HUS:
-
Haemolytic uraemic syndrome
- MAP:
-
Mean arterial pressure
- PRISM:
-
Paediatric Risk of Mortality
- OSF:
-
Organ system failure
- TISS:
-
Therapeutic Intervention Scoring System
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Acknowledgement
This work is dedicated to Prof. Dr. H. M. Grubbauer for his long-term efforts to build up and organise the Paediatric Intensive Care Unit of the Children’s Hospital, Medical University of Graz, Austria, enabling us to start the renal replacement therapy (RRT) program as early as 1985. We thank him for his non-authoritative leadership and honour him as an excellent teacher in paediatrics.
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Pichler, G., Rödl, S., Mache, C. et al. Two decades’ experience of renal replacement therapy in paediatric patients with acute renal failure. Eur J Pediatr 166, 139–144 (2007). https://doi.org/10.1007/s00431-006-0213-1
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DOI: https://doi.org/10.1007/s00431-006-0213-1