Continuous renal replacement therapy (CRRT) after stem cell transplantation. A report from the prospective pediatric CRRT Registry Group.
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.
Flores
Francisco X
FX
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
Brophy
Patrick D
PD
Symons
Jordan M
JM
Fortenberry
James D
JD
Chua
Annabelle N
AN
Alexander
Steven R
SR
Mahan
John D
JD
Bunchman
Timothy E
TE
Blowey
Douglas
D
Somers
Michael J G
MJ
Baum
Michelle
M
Hackbarth
Richard
R
Chand
Deepa
D
McBryde
Kevin
K
Benfield
Mark
M
Goldstein
Stuart L
SL
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