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The Future of Pediatric CRRT

  • William R. Clark
  • Stuart L. Goldstein
  • Jeffrey Letteri
  • Claudio Ronco
Chapter

Abstract

Over the past several decades, the clinical aspects of acute kidney injury (AKI) and its management with renal replacement therapy (RRT) have evolved substantially in both the pediatric and adult patient populations. The development of AKI in children is now recognized to be a common occurrence, especially among critically ill neonates and infants, and is associated with substantial morbidity and mortality. With respect to dialytic management, continuous RRT (CRRT) has supplanted peritoneal dialysis as the preferred dialytic modality for critically ill pediatric AKI patients in many parts of the world, especially the United States. Although initial CRRT devices for both adults and children involved technology adapted from chronic hemodialysis, dedicated CRRT devices specifically designed for critically ill adult patients have been widely available for more than two decades now. However, these devices generally have not had specific indications for pediatric use due to limitations related to fluid accuracy and extracorporeal circuit volumes. The recent introduction of pediatric-specific machines obviates the need to provide CRRT “off-label” with adult-based CRRT devices to small pediatric patients. In this chapter, some of the clinical challenges associated with treating the complex critically ill AKI patient population are discussed and several important questions for the future are addressed. In addition to CRRT technology, the topics of therapy dosing, timing of initiation and termination, fluid management, drug dosing, and data analytics are discussed, with emphasis on anticipated developments over the next decade.

Keywords

Acute kidney injury Pediatric Continuous renal replacement therapy Hemodialysis Dose Quality Fluid overload Timing Precision medicine 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • William R. Clark
    • 1
  • Stuart L. Goldstein
    • 2
  • Jeffrey Letteri
    • 3
  • Claudio Ronco
    • 4
    • 5
  1. 1.Davidson School of Chemical EngineeringPurdue UniversityWest LafayetteUSA
  2. 2.Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical CenterCincinnatiUSA
  3. 3.Medical Affairs, Baxter Healthcare CorporationDeerfieldUSA
  4. 4.International Renal Research Institute of Vicenza (IRRIV), San Bortolo HospitalVicenzaItaly
  5. 5.Department of NephrologySan Bortolo HospitalVicenzaItaly

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