Timing and method of renal replacement therapy in the critical care children / 中国实用儿科杂志

ABSTRACT

Renal replacement therapy(RRT)is effective in supporting impaired kidney function,maintaining homeostasis,as well as removing inflammatory mediators,harmful metabolites and toxin in critically ill children. The accepted timing of initiating RRT in acute kidney injury(AKI)patients are severe metabolic acidosis(p H6.5 mmol/L),uraemic associated encephalopathy and bleeding diathesis,and fluid overload when medical management fails. Continuous renal replacement therapy(CRRT)has become the preferred technique to manage fluid administration in septic AKI or hemodynamically unstable patients,but its adequate timing remains unclear. The dose of CRRT can be divided into renal replacement therapy dose[ultrafiltration dose 20-35 mL/(kg·h)]and sepsis treatment dose[ultrafiltration dose≥35 mL/(kg·h)]. The use of high volume hemofiltration(HVHF)[replacement dose≥50 mL/(kg·h)]has demonstrated clinical benefits in septic shock patients by reversing the abnormal hemodynamics.