title: Outcome in children receiving continuous venovenous hemofiltration.
abstract: OBJECTIVE
  Continuous venovenous hemofiltration (CVVH) alone or with dialysis (D) has become an important supportive therapy for critically ill children with acute renal failure. Previous reports of pediatric patient outcome either mix CVVH/D with other renal replacement modalities or do not examine severity of illness. The current study examines only outcomes of children receiving CVVH/D using Pediatric Risk of Mortality (PRISM) scores to control for severity of illness.
  
  
  METHODS
  Twenty-one patients (mean age: 8.8 +/- 6.3 years; mean weight: 28.3 +/- 20.8 kg) received 22 courses of CVVH/D.
  
  
  RESULTS
  Nine (42.8%) of 21 patients survived. Nine (75%) of 12 deaths occurred within 25 days of pediatric intensive care unit (PICU) admission. Mean PRISM score at PICU admission and CVVH initiation were 13.1 +/- 5.8 and 15.4 +/- 8.9, respectively. Mean patient weight, age, PRISM score at PICU admission and at CVVH/D initiation, maximum pressor number, estimated glomerular filtration rate at CVVH/D initiation and change in mean airway pressure did not differ between survivors and nonsurvivors. The degree of fluid overload at CVVH/D initiation was significantly lower in survivors (16.4% +/- 13.8%) compared with nonsurvivors (34.0% +/- 21.0%), even when controlled for severity of illness by PRISM score. Mean cost of providing CVVH/D accounted for only 1% of total PICU cost per patient.
  
  
  CONCLUSIONS
  The pattern of early multiorgan system failure and death, minimal relative cost of CVVH/D provision, and potential for improved outcome with initiation of CVVH/D at lesser degrees of fluid overload are factors that may support early initiation of CVVH/D in critically ill children with acute renal failure.
authors.affiliation: Department of Pediatrics, Renal Section, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Goldstein
authors.forename: H
authors.initials: H
authors.lastname: Currier
authors.lastname: Graf Cd
authors.forename: C C
authors.initials: CC
authors.lastname: Cosio
authors.forename: E D
authors.initials: ED
authors.lastname: Brewer
authors.forename: R
authors.initials: R
authors.lastname: Sachdeva
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D017048:Health Care Costs; D006440:Hemofiltration / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000191:economics; D009102:Multiple Organ Failure / Q000175:diagnosis; D017582:Renal Replacement Therapy / Q000191:economics / Q000706:statistics & numerical data; D016896:Treatment Outcome