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Outcome of Continuous Renal Replacement Therapy in Children

Korean Journal of Pediatrics 2005;48(1):68-74.
Published online January 15, 2005.
Outcome of Continuous Renal Replacement Therapy in Children
Yeon Jung Lim1, Hyun-seung Jin1, Hyewon Hahn1, Sei Ho Oh2, Seong Jong Park1, Young Seo Park1
1Department of Pediatrics, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
2Department of Pediatrics, Handong University, Sunlin Hospital, Pohang, Korea
소아에서 지속적 신대체요법의 치료 결과
임연정1, 진현승1, 한혜원1, 오세호2, 박성종1, 박영서1
1울산대학교 의과대학 서울아산병원 소아과
2한동대학교 선린병원 소아과
Correspondence: 
Young Seo Park, Email: yspark@amc.seoul.kr
Abstract
Purpose
: There is growing use of continuous renal replacement therapy(CRRT) for pediatric patients, but reports about the use and outcome of CRRT in children is rare in Korea. We report our experiences of CRRT in critically ill pediatric patients.
Methods
: We reviewed the medical records of 23 pediatric patients who underwent CRRT at Asan Medical Center between May 2001 and May 2004. We evaluated underlying diseases, clinical features, treatment courses, CRRT modalities and outcomes.
Results
: Ages ranged from three days to 16 years with a median of five years. Patients weighed 2.4 to 63.9 kg(median 23.0 kg; 10 patients ≤20 kg). The underlying diseases were malignancy(nine cases), multiple organ dysfunction syndrome(five cases), hyperammonemia(four cases), acute renal failure associated with liver failure(three cases), dilated cardiomyopathy(one case) and congenital nephrotic syndrome(one case). Pediatric Risk of Mortality(PRISM) III score was 17.6±7.6 and the mean number of failing organs was 3.0±1.7. Duration of CRRT was one to 27 days(median : nine days). Eleven patients(47.8%) survived. Chronic renal failure developed in two cases, intracranial hemorrhage in one case, and chylothorax in one case among the survivors. PRISM III score and the number of vasopressor before the start of CRRT was significantly lower in the survivors(12.7±4.2 and 0.9±1.1) compared with nonsurvivors(22.1±7.8 and 2.4±1.4)(P<0.05).
Conclusion
: CRRT driven in venovenous mode is an effective and safe method of renal support for critically-ill infants and children to control fluid balance and metabolic derangement. Survival is affected by PRISM III score and the number of vasopressors at the initiation of CRRT.
Key Words: Acute renal failure, Continuous renal replacement therapy, Children


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