Renal replacement therapy in pediatric critical care medicine

PURPOSE OF REVIEW: The use of continuous renal replacement therapy in pediatric critical care has increased in the last 10 years. Adaptive makeshift machinery has been replaced with dedicated volumetric and/or gravimetric devices that afford accurate blood flow and ultrafiltrate production rates. While renal dysfunction continues to be related to primary renal disease, the incidence of secondary causes of acute renal failure continue to grow, especially in patients following cardiothoracic surgery, bone marrow transplantation, respiratory failure and multi-organ dysfunction syndrome. RECENT FINDINGS: Although much of the outcome data for continuous renal replacement therapy has been retrospective in nature, these therapies are safe for use in the sickest of intensive care unit patients. Moreover, early data from the prospective pediatric continuous renal replacement therapy registry suggests that early intervention with continuous renal replacement therapy, as well as goal-directed fluid resuscitation may lead to improved survival in critically ill patients. In patients with sepsis and septic shock, continuous renal replacement therapy offers a means for blood purification. SUMMARY: Though randomized placebo controlled trials are lacking at this time, center-based results suggest that continuous renal replacement therapy may prove beneficial to critically ill patients with sepsis and/or septic shock.