title: Renal replacement therapies in pediatric intensive care patients: experiences of one center in Turkey.
abstract: BACKGROUND
  Despite constant improvements in caring for critically ill neonates and infants with congenital cardiac disease, sepsis, bone marrow and solid organ transplantation, acute renal failure (ARF) is an important problem in these children. ARF, severe fluid overload and inborn errors of metabolism are some of the indications for acute dialysis in infants and children.
  
  
  METHODS
  The authors had retrospectively evaluated the medical records of Pediatric Intensive Care Unit, Ankara University School of Medicine, Ankara, Turkey patients who had required acute renal replacement therapy between the dates of January 2002 to February 2005.
  
  
  RESULTS
  Medical records of 332 patients were reviewed. Acute renal replacement therapy was performed in 21 patients (6.3%; mean age, 9.6 +/- 7.4 years). Dialysis modalities were peritoneal dialysis in 15 patients (71.4%; mean age, 3.9 +/- 5.6 years) and hemodialysis in six patients (28.6%; mean age, 12.1 +/- 3.2 years). A total of 90% of patients had severe systemic disease leading to ARF. A total of 95% of patients had multiple organ dysfunction syndrome. The most common cause of ARF was refractory shock. At the beginning of renal replacement therapy, 10 patients were anuric, nine patients had volume overload, seven patients had decompensated metabolic acidosis and nine patients had hypotension. The average dialysis period was 4.7 +/- 6.4 days. Mortality rate was 66.7%. Eight patients recovered from ARF and chronic renal failure had developed in one patient.
  
  
  CONCLUSIONS
  In the Pediatric Intensive Care Unit, ARF is frequently seen together with multiple organ dysfunction syndrome and the mortality rate is high. Both peritoneal dialysis and hemodialysis are important renal replacement treatment modalities in patients with ARF. The age and hemodynamic status of the patients are important when choosing treatment modality; generally peritoneal dialysis is preferred in infants and toddler, while hemodialysis is preferred in older children.
authors.affiliation: Department of Pediatric Intensive Care Unit, Ankara University School of Medicine, Ankara, Turkey. tanilkendirli@hotmail.com
authors.forename: Tanil
authors.initials: T
authors.lastname: Kendirli
authors.forename: Mesiiha
authors.initials: M
authors.lastname: Ekim
authors.forename: Zeynep Birsin
authors.initials: ZB
authors.lastname: Ozçakar
authors.forename: Selçuk
authors.initials: S
authors.lastname: Yüksel
authors.forename: Banu
authors.initials: B
authors.lastname: Acar
authors.forename: Burcu
authors.initials: B
authors.lastname: Oztürk-Hiişmi
authors.forename: Emel
authors.initials: E
authors.lastname: Derelli
authors.forename: Asli
authors.initials: A
authors.lastname: Kavaz
authors.forename: Zahide
authors.initials: Z
authors.lastname: Yalaki
authors.forename: Fatoş
authors.initials: F
authors.lastname: Yalçinkaya
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality / Q000628:therapy*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D009102:Multiple Organ Failure / Q000401:mortality / Q000628:therapy*; D017582:Renal Replacement Therapy / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology