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Renal Replacement Therapy for Acute Renal Failure

Renal Replacement Therapy for Acute Renal Failure. Timothy E. Bunchman Professor Pediatrics. Infant ARF Single RRT Modality. Ronco et al; Intens Care Med, 1995 45% survival-CRRT Sadowski et al; KI 1995 primary renal disease 71%-HD secondary renal disease 33%-HD.

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Renal Replacement Therapy for Acute Renal Failure

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  1. Renal Replacement Therapy for Acute Renal Failure Timothy E. Bunchman Professor Pediatrics

  2. Infant ARF Single RRT Modality • Ronco et al; Intens Care Med, 1995 • 45% survival-CRRT • Sadowski et al; KI 1995 • primary renal disease 71%-HD • secondary renal disease 33%-HD

  3. Pediatric ARF Single RRT Modality • Niaudet et al; KI, 1985 • 80% survival-primary ARF all RRT • Zobel et al; Ped Neph, 1989 • 65% survival-CRRT • Zobel et al; Contrib Neph, 1991 • 60% survival-CAVH, • 35%-survival- CVVH

  4. Pediatric ARF Single RRT Modality • Paret et al; J Thor Cardiovas Surg , 1992 • 33% survival-CAVH • Gallego et al; Nephron, 1993 • 52% survival with PD/HD • features of poorer prognosis • less then 1 mos of age • hypotension

  5. Pediatric ARF Single RRT Modality • Bradbury et al; Arch Dis Child, 1994 • 33% survival-CVVH • Latta et al; Ped Neph, 1994 • 37% survival-CAVH • Smoyer et al; JASN, 1995 • 43% survival-CRRT

  6. Pediatric ARF Comparison of RRT modalities • Fleming et al; J Thor Cardiovas Surg, 1995 • 38% survival-PD • 33% survival-CAVH • 42% survival-CVVH • Maxvold et al; Am J Kid Dis, 1997 • 43% survival-CVVH • 83% survival-HD

  7. Pediatric ARF Comparison of RRT modalities • Lowrie et al; Ped Neph, 2000 • evaluation of PD vs CVVHF in children with MOSF • survival equal but related to disease state and the number of organs non functioning

  8. Adult ARF Comparison of RRT modalities • Kruczynski et al; ASAIO, 1993 • 75% Survival-CAVH; 18% survival-HD • Bellomo et al; ASAIO, 1993 • 40% Survival-CRRT; 30% survival-HD • van Brommel et al: Am J Neph, 1995 • 43% Survival-CRRT; 59% survival-HD

  9. New Dialysis Patients 1992-1998 (total 354)

  10. Demographics

  11. Modality of Choice at onset

  12. Diagnosis

  13. ARF-282 patients • Time on therapy • HF-8.7 days • HD-9.5 days • PD-9.6 days NS • Heparin Free Therapies • HF-51% • HD-28% < 0.01

  14. Survivors: Analysis by weight NS

  15. Survivors: Analysis byBP at onset p < 0.01 NS

  16. Survivors: Analysis by use of Pressors p < 0.01

  17. Survivors: Analysis by RRT modality NS NS NS p < 0.01

  18. Survivors: Analysis by RRT modality and weight NS NS NS Kg p < 0.05

  19. Survivors: Analysis by Diagnosis and RRT Modality

  20. Analysis by Diagnosis RRT Modality and Pressors P < 0.01 vs HF or PD

  21. Survivors: Analysis by Diagnosis and RRT Modality

  22. Analysis by Diagnosis RRT Modality and Pressors p < 0.01 vs HF or PD (ARF/Liv Tx)

  23. Survivors: Analysis by Diagnosis and RRT Modality

  24. Analysis by Diagnosis RRT Modality and Pressors

  25. RRT for ARF • Best RRT is one that’s continuous, done with ease, and minimizes risk of hypotension, access complications, infectious risk, or coagulation risk • Best local standard is the best modality • Nutritional needs of the child need to be factored in and adjusted for RRT modality

  26. RRT for ARF • Survival is related to diagnosis, hypotension, use of pressor agents and PRISM scores and may be influenced by RRT choice • ARF management needs to be a cooperative effort between Nephrologists and Intensivists for the optimal care of children

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