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The Future of Pediatric CRRT

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Critical Care Nephrology and Renal Replacement Therapy in Children

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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.

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Authors and Affiliations

  1. Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN, USA

    William R. Clark

  2. Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Stuart L. Goldstein

  3. Medical Affairs, Baxter Healthcare Corporation, Deerfield, IL, USA

    Jeffrey Letteri

  4. International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy

    Claudio Ronco

  5. Department of Nephrology, San Bortolo Hospital, Vicenza, Italy

    Claudio Ronco

Authors
  1. William R. Clark
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  2. Stuart L. Goldstein
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  3. Jeffrey Letteri
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  4. Claudio Ronco
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Correspondence to William R. Clark .

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Editors and Affiliations

  1. Paediatric Intensive Care Unit, King’s College Hospital, London, United Kingdom

    Akash Deep

  2. Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA

    Stuart L. Goldstein

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Clark, W.R., Goldstein, S.L., Letteri, J., Ronco, C. (2018). The Future of Pediatric CRRT. In: Deep, A., Goldstein, S. (eds) Critical Care Nephrology and Renal Replacement Therapy in Children. Springer, Cham. https://doi.org/10.1007/978-3-319-90281-4_24

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  • DOI: https://doi.org/10.1007/978-3-319-90281-4_24

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