Continuous renal replacement therapy (CRRT) after stem cell transplantation. A report from the prospective pediatric CRRT Registry Group |
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| Authors: | Francisco X. Flores Patrick D. Brophy Jordan M. Symons James D. Fortenberry Annabelle N. Chua Steven R. Alexander John D. Mahan Timothy E. Bunchman Douglas Blowey Michael J. G. Somers Michelle Baum Richard Hackbarth Deepa Chand Kevin McBryde Mark Benfield Stuart L. Goldstein |
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| Affiliation: | (1) Department of Pediatrics, Division of Nephrology, University of South Florida College of Medicine, All Children’s Hospital, St. Petersburg, FL, USA;(2) Department of Pediatric Nephrology, C.S. Mott Children’s Hospital, Ann Arbor, MI, USA;(3) Department of Pediatrics, University of Washington School of Medicine and Children’s Hospital & Regional Medical Center, Seattle, WA, USA;(4) Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta at Egleston, Atlanta, GA, USA;(5) Department of Pediatrics, Renal Section, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA;(6) Department of Pediatrics, Stanford School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA, USA;(7) Department of Pediatrics, Ohio State University College of Medicine and Public Health and Columbus Children’s Hospital, Columbus, OH, USA;(8) Department of Pediatrics and Human Development, Michigan State University and DeVos Children’s Hospital, Grand Rapids, MI, USA;(9) Department of Pediatric Nephrology, Children’s Mercy Hospital and Clinics, Kansas City, MO, USA;(10) Department of Pediatrics, Division of Nephrology, Harvard Medical School and Children’s Hospital, Boston, MA, USA;(11) Section of Pediatric Nephrology, The Children’s Hospital at the Cleveland Clinic, Cleveland, OH, USA;(12) Department of Nephrology, Children’s National Medical Center, Washington, DC, USA;(13) Division of Pediatric Nephrology, Children’s Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA;(14) The Prospective Pediatric CRRT Registry Group, Houston, TX, USA |
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| Abstract: | Pediatric stem cell transplant (SCT) recipients commonly develop acute renal failure (ARF). We report the demographic and survival data of pediatric SCT patients enrolled in the Prospective Pediatric Continuous Renal Replacement Therapy (ppCRRT) Registry. Since 1 January 2001, 51/370 (13.8%) patients entered in the ppCRRT Registry had received a SCT. Median age was 13.63 (0.53–23.52) years. The primary reasons for the initiation of continuous renal replacement therapy (CRRT) were treatment of fluid overload (FO) and electrolyte imbalance (49%), FO only (39%), electrolyte imbalance only (8%) and other reasons (4%). The CRRT modalities included continuous veno-veno hemodialysis (CVVHD), 43%, continuous veno-veno hemofiltration (CVVH), 37% and continuous veno-veno hemodiafiltration (CVVHDF), 20%. Seventy-six percent had multi-organ dysfunction syndrome (MODS), 72% received ventilatory support and the mean FO was 12.41 ± 3.70%. Forty-five percent of patients survived. Patients receiving convective therapies had better survival rates (59% vs 27%, P < 0.05). Patients requiring ventilatory support had worse survival (35% vs 71%, P < 0.05). Mean airway pressure (Paw) at the end of CRRT was lower in survivors (8.7 ± 2.94 vs 25.76 ± 2.03 mmH2O, P < 0.05). Development of high mean airway pressure in non-survivors is likely related to non-fluid injury, as it was not prevented by early and aggressive fluid management by CRRT therapy. |
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| Keywords: | Hemofiltration Pediatric Acute renal failure Continuous renal replacement therapy Bone marrow transplant |
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