Hemopurification in paediatric intensive care

Abstract

Acute renal failure is defined as the cessation of renal function with or without changes in urinary output. The incidence of acute renal failure in paediatric intensive care units is highly variable, ranging from 2%–8% [1]. Acute renal failure in infants and children is often associated with severe medical or surgical illness. If conventional therapy fails to control fluid and metabolic balance, extracorporeal renal replacement therapy has to be instituted [2]. Intermittent hemodialysis and peritoneal dialysis are not always feasible in critically ill patients for both technical and clinical reasons [1]. Continuous hemofiltration, either driven in the arteriovenous or venovenous mode, is an alternative continuous renal replacement therapy (CRRT) to control fluid and metabolic balance [3, 4]. In 1977, Kramer et al. first described continuous arteriovenous hemofiltration (CAVH) for extracorporeal renal support in oliguric adults with diuretic-resistant fluid overload [5]. Recently, this technique has been used in critically ill paediatric patients [6–12]. During CAVH the blood is driven through the hemofilter by the arteriovenous pressure gradient. Fluid and solutes are removed by convective transport. The great advantage of CAVH is its simplicity, safety, and excellent clinical tolerance. However, arterial cannulation carries the risk of arterial thrombosis or thromboembolism. In addition, low efficiency and frequent hemofilter clotting are the disadvantages of CRRT.