title: Controversies in paediatric continuous renal replacement therapy.
abstract: BACKGROUND
  Continuous renal replacement therapy (CRRT) is an invaluable means of supporting critically ill children with many illnesses, including acute renal failure, drug intoxication, inborn errors of metabolism, and multiorgan failure. However, the ideal method of applying the technique is unknown.
  
  
  CONCLUSIONS
  The indications for initiation of CRRT, mode, dose, and means of anticoagulating the circuit to prolong filter life are all subjects of controversy. The formation of a prospective, multicentre paediatric CRRT registry has been a major step forward but large, randomised trials of the sort that exist in adult medicine are lacking. This review describes the basic technique of CRRT, highlights the differences between adult and paediatric prescription, and elaborates on the main controversies in the application of CRRT in children.
  
  
  CONCLUSIONS
  Current evidence suggests that early initiation of CRRT before the onset of substantial fluid overload, considering continuous haemofiltration in disease states such as respiratory failure following stem cell transplantation, and the use of continuous haemodialysis and citrate anticoagulation to prolong circuit life may be associated with improved outcomes.
authors.affiliation: Departments of Paediatrics and Cardiac Surgery, National University Health System, Singapore, Singapore. gmaclaren@iinet.net.au
authors.forename: Graeme
authors.initials: G
authors.lastname: Maclaren
authors.forename: Warwick
authors.initials: W
authors.lastname: Butt
mesh_terms: D000328:Adult; D002404:Catheterization / Q000295:instrumentation; D002648:Child; D004867:Equipment Design; D006440:Hemofiltration / Q000295:instrumentation; D006801:Humans; D011446:Prospective Studies; D012042:Registries; D051437:Renal Insufficiency / Q000628:therapy*; D017582:Renal Replacement Therapy / Q000295:instrumentation* / Q000379:methods