title: Continuous renal replacement therapy (CRRT) after stem cell transplantation. A report from the prospective pediatric CRRT Registry Group.
abstract: Pediatric stem cell transplant (SCT) recipients commonly develop acute renal failure (ARF). We report the demographic and survival data of pediatric SCT patients enrolled in the Prospective Pediatric Continuous Renal Replacement Therapy (ppCRRT) Registry. Since 1 January 2001, 51/370 (13.8%) patients entered in the ppCRRT Registry had received a SCT. Median age was 13.63 (0.53-23.52) years. The primary reasons for the initiation of continuous renal replacement therapy (CRRT) were treatment of fluid overload (FO) and electrolyte imbalance (49%), FO only (39%), electrolyte imbalance only (8%) and other reasons (4%). The CRRT modalities included continuous veno-veno hemodialysis (CVVHD), 43%, continuous veno-veno hemofiltration (CVVH), 37% and continuous veno-veno hemodiafiltration (CVVHDF), 20%. Seventy-six percent had multi-organ dysfunction syndrome (MODS), 72% received ventilatory support and the mean FO was 12.41 +/- 3.70%. Forty-five percent of patients survived. Patients receiving convective therapies had better survival rates (59% vs 27%, P < 0.05). Patients requiring ventilatory support had worse survival (35% vs 71%, P < 0.05). Mean airway pressure (Paw) at the end of CRRT was lower in survivors (8.7 +/- 2.94 vs 25.76 +/- 2.03 mmH(2)O, P < 0.05). Development of high mean airway pressure in non-survivors is likely related to non-fluid injury, as it was not prevented by early and aggressive fluid management by CRRT therapy.
authors.affiliation: Department of Pediatrics, Division of Nephrology, University of South Florida College of Medicine, All Children's Hospital, St Petersburg, FL, USA. fflores@hsc.usf.edu
authors.forename: Francisco X
authors.initials: FX
authors.lastname: Flores
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Brophy
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Symons
authors.forename: James D
authors.initials: JD
authors.lastname: Fortenberry
authors.forename: Annabelle N
authors.initials: AN
authors.lastname: Chua
authors.forename: Steven R
authors.initials: SR
authors.lastname: Alexander
authors.forename: John D
authors.initials: JD
authors.lastname: Mahan
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Bunchman
authors.forename: Douglas
authors.initials: D
authors.lastname: Blowey
authors.forename: Michael J G
authors.initials: MJ
authors.lastname: Somers
authors.forename: Michelle
authors.initials: M
authors.lastname: Baum
authors.forename: Richard
authors.initials: R
authors.lastname: Hackbarth
authors.forename: Deepa
authors.initials: D
authors.lastname: Chand
authors.forename: Kevin
authors.initials: K
authors.lastname: McBryde
authors.forename: Mark
authors.initials: M
authors.lastname: Benfield
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldstein
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006440:Hemofiltration; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D012042:Registries; D006435:Renal Dialysis; D017582:Renal Replacement Therapy / Q000379:methods*; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology