CRRT in a Sick Child

  • Timothy E. BunchmanEmail author


A 30 kg child with leukemia develops septic shock with multi-organ system failure including the need for intubation, vasopressor support for hemodynamic compromise, as well as progressive oliguria with both solute and fluid retention. Current ventilator settings include a FIO2 delivery of 70%, a PEEP of 10. Blood pressure is currently 98/45 with 1 mic/kg/min of norepinephrine adjustment to keep at systolic >110 mmHg. The child is febrile with a temperature of 39 °C. Fluid overload calculations reveal that the child is 15% above dry weight with insufficient urine output to allow for adequate room for medications, nutrition, and overall medical care. Labs reveal a BUN of 69 mg/dL, a cr of 2.3 mg/dL, and a K of 5.9 meq/dL.


  1. 1.
    Barletta GM, Bunchman TE. Acute renal failure in children and infants. Curr Opin Crit Care. 2004;10(6):499–504.CrossRefGoogle Scholar
  2. 2.
    Maxvold NJ, Smoyer WE, Custer JR, Bunchman TE. Amino acid loss and nitrogen balance in critically ill children with acute renal failure: a prospective comparison between classic hemofiltration and hemofiltration with dialysis. Crit Care Med. 2000;28(4):1161–5.CrossRefGoogle Scholar
  3. 3.
    Flores FX, Brophy PD, Symons JM, et al. Continuous renal replacement therapy (CRRT) after stem cell transplantation. A report from the prospective pediatric CRRT Registry Group. Pediatr Nephrol. 2008;23(4):625–30.CrossRefGoogle Scholar
  4. 4.
    Lorenzin A, Garzotto F, Alghisi A, et al. CVVHD treatment with CARPEDIEM: small solute clearance at different blood and dialysate flows with three different surface area filter configurations. Pediatr Nephrol. 2016;31(10):1659–65.CrossRefGoogle Scholar
  5. 5.
    Coulthard MG, Crosier J, Griffiths C, et al. Haemodialysing babies weighing <8 kg with the Newcastle infant dialysis and ultrafiltration system (Nidus): comparison with peritoneal and conventional haemodialysis. Pediatr Nephrol. 2014;29(10):1873–81.CrossRefGoogle Scholar
  6. 6.
    Hackbarth R, Bunchman TE, Chua AN, et al. The effect of vascular access location and size on circuit survival in pediatric continuous renal replacement therapy: a report from the PPCRRT registry. Int J Artif Organs. 2007;30(12):1116–21.CrossRefGoogle Scholar
  7. 7.
    Mehta RL, McDonald BR, Aguilar MM, Ward DM. Regional citrate anticoagulation for continuous arteriovenous hemodialysis in critically ill patients. Kidney Int. 1990;38(5):976–81.CrossRefGoogle Scholar
  8. 8.
    Bunchman TE, Maxvold NJ, Barnett J, et al. Pediatric hemofiltration: Normocarb dialysate solution with citrate anticoagulation. Pediatr Nephrol. 2002;17(3):150–4.CrossRefGoogle Scholar
  9. 9.
    Deep A, Zoha M, Dutta KP. Prostacyclin as an anticoagulant for continuous renal replacement therapy in children. Blood Purif. 2017;43(4):279–89.CrossRefGoogle Scholar
  10. 10.
    Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, La Greca G. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet. 2000;356(9223):26–30.CrossRefGoogle Scholar
  11. 11.
    Brophy PD, Somers MJ, Baum MA, et al. Multi-centre evaluation of anticoagulation in patients receiving continuous renal replacement therapy (CRRT). Nephrol Dial Transplant. 2005;20(7):1416–21.CrossRefGoogle Scholar
  12. 12.
    Brophy PD, Mottes TA, Kudelka TL, et al. AN-69 membrane reactions are pH-dependent and preventable. Am J Kidney Dis. 2001;38(1):173–8.CrossRefGoogle Scholar
  13. 13.
    Hackbarth RM, Eding D, Gianoli Smith C, et al. Zero balance ultrafiltration (Z-BUF) in blood-primed CRRT circuits achieves electrolyte and acid-base homeostasis prior to patient connection. Pediatr Nephrol. 2005;20(9):1328–33.CrossRefGoogle Scholar
  14. 14.
    Zappitelli M, Goldstein SL, Symons JM, et al. Protein and calorie prescription for children and young adults receiving continuous renal replacement therapy: a report from the Prospective Pediatric Continuous Renal Replacement Therapy Registry Group. Crit Care Med. 2008;36(12):3239–45.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Children’s Hospital of Richmond at Virginia Commonwealth UniversityRichmondUSA

Personalised recommendations