Renal Replacement Therapies and Other Extracorporeal Therapies

  • Andrew L. Schwaderer
  • Marc B. Lande


Renal replacement therapy is an important component in the care of children with acute kidney injury (AKI), inborn errors of metabolism, and certain intoxications that respond inadequately to conservative measures (Table 15-1). Advancements in the treatment of children with bone marrow and solid organ transplantation, congenital cardiac disease and critically ill neonates have lead to an increase in the prevalence of AKI. Peritoneal dialysis (PD) has historically been the most common renal replacement modality for the treatment of AKI in children due to its ease of implementation. However, due to developments in equipment and techniques for hemodialysis (HD) and continuous hemofiltration, the use of these modalities now surpasses the use of PD for AKI in children. The disadvantages and advantages of each modality, the goal of therapy, the clinical status of the patient, and the institutional resources influence the choice of renal replacement modality for a specific patient. Pediatric patients require special considerations due to the wide range of body sizes encountered and due to an increased prevalence of disease states that requires renal replacement therapy in the absence of severe renal dysfunction, such as inborn errors of metabolism.


Peritoneal Dialysis Renal Replacement Therapy Continuous Renal Replacement Therapy Blood Flow Rate Intermittent Hemodialysis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Suggested Readings

  1. Bellomo R, Ronco C. Continuous haemofiltration in the intensive care unit. Crit Care. 2000;4:339–45.PubMedCrossRefGoogle Scholar
  2. Bunchman TE. Plasmapheresis and renal replacement therapy in children. Curr Opin Pediatr. 2002;14:310–4.PubMedCrossRefGoogle Scholar
  3. Bunchman TE, Donckerwolcke RA. Continuous arterial-venous dihemofiltration and continuous veno-venous dihemofiltration in infants and children. Pediatr Nephrol. 1994;8:96–102.PubMedCrossRefGoogle Scholar
  4. Bunchman TE, Maxvold NJ, Brophy PD. Pediatric convective hemofiltration: Normocarb replacement fluid and citrate anticoagulation. Am J Kidney Dis. 2003;42:1248–52.PubMedCrossRefGoogle Scholar
  5. Cole L, Bellomo R, Hart G, et al. A phase II randomized, controlled trial of continuous hemofiltration in sepsis. Crit Care Med. 2002;30:100–6.PubMedCrossRefGoogle Scholar
  6. De Palo T, Giordano M, Bellantuono R, et al. Therapeutic apheresis in children: experience in a pediatric dialysis center. Int J Artif Organs. 2000;23:834–9.PubMedGoogle Scholar
  7. Elhanan N, Skippen P, Nuthall G, Krahn G. Citrate anticoagulation in pediatric continuous venovenous hemofiltration. Pediatr Nephrol. 2003;19:208–12.PubMedGoogle Scholar
  8. Evans ED, Greenbaum LA, Ettenger RB. Principals of renal replacement therapy in children. Pediatr Clin North Am. 1995;42: 1579–602.PubMedGoogle Scholar
  9. Flynn JT. Choice of dialysis modality for management of pediatric acute renal failure. Pediatr Nephrol. 2002;17:61–9.PubMedCrossRefGoogle Scholar
  10. Flynn JT, Kershaw DB, Smoyer WE, Brophy PD, McBryde KD, Bunchman TE. Peritoneal dialysis for management of pediatric acute renal failure. Perit Dial Int. 2001;21:390–4.PubMedGoogle Scholar
  11. Foland JA, Fortenberry JD, Warshaw BL, et al. Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis. Crit Care Med. 2004;32:1771–6.PubMedCrossRefGoogle Scholar
  12. Gillespie RS, Siedel K, Symons JM. Effect of fluid overload and dose of replacement fluid on survival in hemofiltration. Pediatr Nephrol. 2004;19:1394–9.PubMedCrossRefGoogle Scholar
  13. Goldstein SL. Overview of pediatric renal replacement therapy in acute renal failure. Artif Organs. 2003;27:781–5.PubMedCrossRefGoogle Scholar
  14. Gong WK, Tan TH, Foong PP, Murugasu B, Yap HK. Eighteen years experience in pediatric acute dialysis: analysis of predictors of outcome. Pediatr Nephrol. 2001;16:212–5.PubMedCrossRefGoogle Scholar
  15. Grunberg J, Rebori A, Verocay MC. Peritoneal dialysis in children with spinal bifida and ventriculoperitoneal shunt: one center’s experience and review of the literature. Perit Dial Int. 2003; 23:481–6.PubMedGoogle Scholar
  16. Kim HC. Therapeutic pediatric apheresis. J Clin Apher. 2000;15:129–57.PubMedCrossRefGoogle Scholar
  17. Kohli HS, Bhalla D, Sud K, Jha V, Gupta KL, Sakhuja V. Acute peritoneal dialysis in neonates: comparison of two types of peritoneal access. Pediatr Nephrol. 1999;13:241–4.PubMedCrossRefGoogle Scholar
  18. 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;28:1161–5.PubMedCrossRefGoogle Scholar
  19. Mayer S, Peter S. Continuous flow peritoneal dialysis as a method to treat anasarca in children with acute respiratory distress syndrome. Crit Care Med. 1999;27:2532–6.CrossRefGoogle Scholar
  20. Moake JL. Thrombotic microangiopathies. N Engl J Med. 2002;347:589–600.PubMedCrossRefGoogle Scholar
  21. Podel J, Hodelin-Wetzel R, Saha DC, Burns G. Glucose absorption in acute peritoneal dialysis. J Ren Nutr. 2000;10:93–7.PubMedCrossRefGoogle Scholar
  22. RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, Cole L, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009;361:1627–38.CrossRefGoogle Scholar
  23. Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure. Lancet. 2000;356:26–30.PubMedCrossRefGoogle Scholar
  24. Ronco C, Bellomo R, Kellum JA. Continuous renal replacement therapy: opinions and evidence. Adv Ren Replace Ther. 2002;9: 229–44.PubMedCrossRefGoogle Scholar
  25. Schiffl H, Lang SM, Fischer R. Daily hemodialysis and the outcome of acute renal failure. N Engl J Med. 2002;346:305–10.PubMedCrossRefGoogle Scholar
  26. Sorof JM, Stromberg D, Brewer ED, Felts TF, Fraser CD. Early initiation of peritoneal dialysis after surgical repair of congenital heart disease. Pediatr Nephrol. 1998;13:641–5.CrossRefGoogle Scholar
  27. Strazdins V, Watson AR, Harvey B. Renal replacement therapy for acute renal failure in children: European guidelines. Pediatr Nephrol. 2004;19:199–207.PubMedCrossRefGoogle Scholar
  28. Symons JM, Brophy PD, Gregory MJ, et al. Continuous renal replacement therapy in children up to 10 kg. Am J Kidney Dis. 2003;41:984–9.PubMedCrossRefGoogle Scholar
  29. Szczepiorkowski ZM, Bandarenko N, Kim HC, et al. Guidelines on the use of therapeutic apheresis in clinical practice: evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher. 2007;22:106–75.PubMedCrossRefGoogle Scholar
  30. Tolwani AJ, Prendergast MB, Speer RR, Stofan BS, Wille KM. A practical citrate anticoagulation continuous venovenous hemodiafiltration protocol for metabolic control and high solute clearance. Clin J Am Soc Nephrol. 2006;1:79–87.PubMedCrossRefGoogle Scholar
  31. Uchino S, Fealy N, Baldwin I, Morimatsu H, Bellomo R. Pre-dilution vs. post-dilution during continuous veno-venous hemofiltration: impact on filter life and azotemic control. Nephron Clin Pract. 2003;94:c94–8.PubMedCrossRefGoogle Scholar
  32. Uchino S, Fealy N, Baldwin I, Morimatsu H, Bellomo R. Continuous venovenous hemofiltration without anticoagulation. ASAIO J. 2004;50:76–80.PubMedCrossRefGoogle Scholar
  33. Veltri M, Neu A, Fivush B, Parekh R, Furth S. Drug dosing during intermittent hemodialysis and continuous renal replacement therapy. Pediatr Drugs. 2004;6:45–65.CrossRefGoogle Scholar
  34. Warady BA, Bunchman T. Dialysis therapy for children with acute renal failure: survey results. Pediatr Nephrol. 2000;15:11–3.PubMedCrossRefGoogle Scholar
  35. Warady BA, Jabs KL, Goldstein SL. Chronic Dialysis in Children. In: Henrich WL, editor. Principles and practice of dialysis. Philadelphia: Lippincott Williams and Wilkins; 2004. p. 592–616.Google Scholar
  36. Yorgin PD, Belson A, Lemley KV. Continuous renal replacement therapy in neonates and young infants. Neoreviews. 2000;1: e163–72.CrossRefGoogle Scholar
  37. Zobel G, Rodl S, Urles B, Kuttnig-Haim M, Ring E. Continuous renal replacement therapy in critically ill neonates. Kidney Int. 1998;53:S169–73.Google Scholar

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  1. 1.Pediatric Nephrology, Department of PediatricsThe Ohio State University College of Medicine, Nationwide Children’s HospitalColumbusUSA
  2. 2.Pediatric Nephrology, Department of PediatricsUniversity of Rochester School of Medicine and Dentistry, Golisano Children’s HospitalRochesterUSA

Personalised recommendations