Timing and method of renal replacement therapy in the critical care children
- Author:
Yun CUI
1
;
Yu-cai ZHANG
1
Author Information
- Publication Type:Journal Article
- Keywords: renal replacement therapy; timing; dose; critically ill; child
- From: Chinese Journal of Practical Pediatrics 2019;34(12):1005-1009
- CountryChina
- Language:Chinese
- Abstract: Renal replacement therapy(RRT)is effective in supporting impaired kidney function,maintaining homeostasis,as well as removing inflammatory mediators,harmful metabolites and toxin in critically ill children. The accepted timing of initiating RRT in acute kidney injury(AKI)patients are severe metabolic acidosis(p H<7.1),hyperkalaemia(K+>6.5 mmol/L),uraemic associated encephalopathy and bleeding diathesis,and fluid overload when medical management fails. Continuous renal replacement therapy(CRRT)has become the preferred technique to manage fluid administration in septic AKI or hemodynamically unstable patients,but its adequate timing remains unclear. The dose of CRRT can be divided into renal replacement therapy dose[ultrafiltration dose 20-35 mL/(kg·h)]and sepsis treatment dose[ultrafiltration dose≥35 mL/(kg·h)]. The use of high volume hemofiltration(HVHF)[replacement dose≥50 mL/(kg·h)]has demonstrated clinical benefits in septic shock patients by reversing the abnormal hemodynamics.
