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Kidney replacement therapy in pediatric patients on mechanical circulatory support: challenges for the pediatric nephrologist

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Abstract

The use of mechanical circulatory support (MCS) therapies in children with medically refractory cardiac failure has increased over the past two decades. With the growing experience and expertise, MCS is currently offered as a bridge to recovery or heart transplantation and in some cases even as destination therapy. Acute kidney injury (AKI) is common in patients with end-stage heart failure (ESHF). When severe AKI develops requiring kidney replacement therapy (KRT), these patients present unique challenges for the pediatric nephrology team. The use of KRT has not been adequately described in children with ESHF on the newer MCS. We also present original case series data from our center experience. The purpose of this review is to familiarize the reader with the current MCS technologies, approach to their selection, how they interact when combined with current KRT circuits, and distinguish similarities and differences. We will attempt to highlight the distinctive features of each technology, specifically focusing on growing trends in use of continuous-flow ventricular assist devices (CF-VAD) as it poses additional challenges to the pediatric nephrologist.

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Acknowledgments

The authors gratefully acknowledge the support from all staff members at Texas Children’s Hospital critical care and dialysis unit.

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Authors and Affiliations

  1. Department of Pediatrics, Renal Section, Baylor College of Medicine, Texas Children’s Hospital, 1102 Bates St., Suite 245, Houston, TX, 77030, USA

    Alexandra Idrovo & Ayse Akcan-Arikan

  2. Department of Pediatrics, Critical Care Section, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Natasha Afonso, Jack Price, Sebastian Tume & Ayse Akcan-Arikan

  3. Department of Pediatrics, Cardiology Section, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Jack Price

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  1. Alexandra Idrovo
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Correspondence to Alexandra Idrovo.

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Idrovo, A., Afonso, N., Price, J. et al. Kidney replacement therapy in pediatric patients on mechanical circulatory support: challenges for the pediatric nephrologist. Pediatr Nephrol 36, 1109–1117 (2021). https://doi.org/10.1007/s00467-020-04605-4

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  • DOI: https://doi.org/10.1007/s00467-020-04605-4

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