title: Metabolic disturbances following the use of inadequate solutions for hemofiltration in acute renal failure.
abstract: Continuous renal replacement therapy (CRRT) has become an important supportive therapy for critically ill children with acute renal failure. In Turkey, commercially available diafiltration and replacement fluids cannot be found on the market. Instead, peritoneal dialysis fluids for dialysis and normal saline as replacement fluid are used. The first objective of this study was to examine metabolic complications due to CRRT treatments. The second objective was to determine demographic characteristics and outcomes of patients who receive CRRT. We did a retrospective chart review of all pediatric patients treated with CRRT between February and December 2004. Thirteen patients received CRRT; seven survived (53.8%). All patients were treated with continuous venovenous hemodiafiltration. Median patient age was 71.8 +/- 78.8 (1.5-180) months. Hyperglycemia occurred in 76.9% (n=10), and metabolic acidosis occurred in 53.8% (n=7) of patients. Median age was younger (48.8 vs.106.2 months), median urea level (106.2 vs. 71 mg/dl) and percent fluid overload (FO) (17.2% vs. 7.6%, respectively) were higher, and CRRT initiation time was longer (8.6 vs 5.6 days) in nonsurvivors vs. survivors for all patients, although these were not statistically significant. CRRT was stopped in all survivors, and four nonsurvivors (67%) were on renal replacement therapy at the time of death. Hyperglycemia and metabolic acidosis were frequently seen in CRRT patients when commercially available diafiltration fluids were not available. Using peritoneal dialysis fluid as dialysate is not a preferable solution. Early initiation of CRRT offered survival benefits to critically ill pediatric patients. Mortality was associated with the primary disease diagnosis.
authors.affiliation: Department of Pediatric Intensive Care, Istanbul Medical Faculty, Istanbul, Turkey.
authors.forename: Demet Demirkol
authors.initials: DD
authors.lastname: Soysal
authors.forename: Metin
authors.initials: M
authors.lastname: Karaböcüoğlu
authors.forename: Agop
authors.initials: A
authors.lastname: Citak
authors.forename: Raif
authors.initials: R
authors.lastname: Uçsel
authors.forename: Nedret
authors.initials: N
authors.lastname: Uzel
authors.forename: Ahmet
authors.initials: A
authors.lastname: Nayir
mesh_terms: D000138:Acidosis / Q000453:epidemiology; D058186:Acute Kidney Injury / Q000401:mortality / Q000628:therapy*; D001639:Bicarbonates / Q000627:therapeutic use; D002648:Child; D005440:Fluid Therapy / Q000009:adverse effects; D005919:Glomerular Filtration Rate; D006440:Hemofiltration / Q000009:adverse effects*; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology; D007328:Insulin / Q000627:therapeutic use; D008659:Metabolic Diseases / Q000209:etiology*; D009102:Multiple Organ Failure / Q000209:etiology; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D001639:Bicarbonates; D007328:Insulin