Nonrenal indications for continuous renal replacement therapy:  A report from the Prospective Pediatric Continuous Renal Replacement Therapy Registry Group.
OBJECTIVE
Continuous renal replacement therapy is the most often implemented dialysis modality in the pediatric intensive care unit setting for patients with acute kidney injury. However, it also has a role in the management of patients with nonrenal indications such as clearance of drugs and intermediates of disordered cellular metabolism.


METHODS
Using data from the multicenter Prospective Pediatric Continuous Renal Replacement Therapy Registry, we report a cohort of pediatric patients receiving continuous renal replacement therapy for nonrenal indications. Nonrenal indications were obtained from the combination of "other" category for continuous renal replacement therapy initiation and patient diagnosis (both primary and secondary). This cohort was further divided into three subgroups: inborn errors of metabolism, drug toxicity, and tumor lysis syndrome.


RESULTS
From 2000 to 2005, a total of 50 continuous renal replacement therapy events with nonrenal indications for therapy were included in the Prospective Pediatric Continuous Renal Replacement Therapy Registry. Indication-specific survival of the subgroups was 62% (inborn errors of metabolism), 82% (tumor lysis syndrome), and 95% (drug toxicity). The median small solute dose delivered among the subgroups ranged from 2125 to 8213 mL/1.73 m/hr, with 54%-59% receiving solely diffusion-based clearance as continuous venovenous hemodialysis. No association was established between survival and dose delivered, modality of continuous renal replacement therapy, or use of intermittent hemodialysis prior to continuous renal replacement therapy.


CONCLUSIONS
Pediatric patients requiring continuous renal replacement therapy for nonrenal indications are a distinct cohort within the population receiving renal replacement therapy with little published experience of outcomes for this group. Survival within this cohort varies by indication for continuous renal replacement therapy and is not associated with continuous renal replacement therapy modality. Additionally, survival is not associated with small solute doses delivered within a cohort receiving >2000 mL/1.73 m/hr. Our data suggest metabolic control is established rapidly in pediatric patients and that acute detoxification may be provided with continuous renal replacement therapy for both the initial and maintenance phases of treatment using either convection or diffusion at appropriate doses.
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA. Geoffrey.fleming@vanderbilt.edu
Geoffrey M
GM
Fleming
Scott
S
Walters
Stuart L
SL
Goldstein
Steven R
SR
Alexander
Michelle A
MA
Baum
Douglas L
DL
Blowey
Timothy E
TE
Bunchman
Annabelle N
AN
Chua
Sarah A
SA
Fletcher
Francisco X
FX
Flores
James D
JD
Fortenberry
Richard
R
Hackbarth
Kevin
K
McBryde
Michael J G
MJ
Somers
Jordan M
JM
Symons
Patrick D
PD
Brophy
D000293:Adolescent; D019540:Area Under Curve; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D064420:Drug-Related Side Effects and Adverse Reactions / Q000628:therapy*; D015312:Hemodialysis Solutions / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008661:Metabolism, Inborn Errors / Q000628:therapy*; D016017:Odds Ratio; D012042:Registries; D017582:Renal Replacement Therapy; D016019:Survival Analysis; D015275:Tumor Lysis Syndrome / Q000628:therapy*
D015312:Hemodialysis Solutions