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Kidney Week

Abstract: TH-PO788

Guidelines on Prescribing Prolonged Intermittent Renal Replacement Therapy (PIRRT) in a Child in an ICU Setting

Session Information

  • Pediatric CKD
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Radhakrishnan, Yeshwanter, Cleveland Clinic Akron General, Akron, Ohio, United States
  • Raina, Rupesh, Cleveland Clinic Akron General, Akron, Ohio, United States
  • Grewal, Manpreet Kaur, Akron Nephrology Associates, Akron, Ohio, United States
Background

Renal replacement therapies (RRT) are a cornerstone in the management of critically ill children who are often hemodynamically compromised. By virtue of their small size and large volume required in the extracorporeal circuit it often becomes difficult to perform conventional hemodialysis to provide RRT support in these children. Continuous renal replacement therapy (CRRT) is the accepted alternative but is associated with the high cost and limited availability. Thus, in resource-poor settings, peritoneal dialysis becomes the mainstay of management but has the disadvantages of increased risk of infections, inability to control the ultrafiltration and interfering with the ventilatory parameters. Prolonged intermittent renal replacement therapy (PIRRT) which is RRT given intermittently over a prolonged session is a modality that provides the advantages of a CRRT in a cost-effective way. PIRRT has been widely accepted in adults but data on PIRRT in children is sparse.

Methods

We searched the PubMed/Medline, Embase and Cochrane Database for all the publications on PIRRT and two experts from the Pediatric Continuous Renal Replacement Therapy (PCRRT) Workgroup assessed titles, abstracts, and full-text articles for extraction of data. The data from the literature search was shared with the PCRRT workgroup and expert panel recommendations were developed.

Results

We recommend that sustained low-efficiency dialysis (SLED) be initiated for all critically ill children requiring RRT along with inotropic support if necessary. SLED should also be initiated for acute kidney injury (AKI) with multi-organ dysfunction and poor Pediatric Risk of Mortality (PRISM) scores. The rates of blood flow and dialysate flow are decided based on hemodynamic stability and are usually similar to CRRT. Duration of therapy may be anywhere between 6-18 hours and may be performed 3 times a week or more. Any machine that is used for IHD may be used for delivering PIRRT provided it has the provision of lowering the blood flow and dialysate flow rates and can prolong the duration of therapy to 6-8 hours.

Conclusion

We recommend that sustained low-efficiency dialysis (SLED) be initiated for all critically ill children requiring RRT along with inotropic support if necessary.