TY - JOUR
T1 - Continuous renal replacement therapy (CRRT) after stem cell transplantation. A report from the prospective pediatric CRRT Registry Group
AU - Flores, Francisco X.
AU - Brophy, Patrick D.
AU - Symons, Jordan M.
AU - Fortenberry, James D.
AU - Chua, Annabelle N.
AU - Alexander, Steven R.
AU - Mahan, John D.
AU - Bunchman, Timothy E.
AU - Blowey, Douglas
AU - Somers, Michael J.G.
AU - Baum, Michelle
AU - Hackbarth, Richard
AU - Chand, Deepa
AU - McBryde, Kevin
AU - Benfield, Mark
AU - Goldstein, Stuart L.
PY - 2008/4
Y1 - 2008/4
N2 - 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.
AB - 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.
KW - Acute renal failure
KW - Bone marrow transplant
KW - Continuous renal replacement therapy
KW - Hemofiltration
KW - Pediatric
UR - http://www.scopus.com/inward/record.url?scp=40549085745&partnerID=8YFLogxK
U2 - 10.1007/s00467-007-0672-2
DO - 10.1007/s00467-007-0672-2
M3 - Article
C2 - 18228045
AN - SCOPUS:40549085745
SN - 0931-041X
VL - 23
SP - 625
EP - 630
JO - Pediatric Nephrology
JF - Pediatric Nephrology
IS - 4
ER -