Renal Replacement Therapy for Acute Renal Failure Timothy

Renal Replacement Therapy for Acute Renal Failure Timothy E. Bunchman Professor Pediatrics

Infant ARF Single RRT Modality • Ronco et al; Intens Care Med, 1995 45% survival-CRRT • Sadowski et al; KI 1995 primary renal disease 71%-HD secondary renal disease 33%-HD bunchman

Pediatric ARF Single RRT Modality • Niaudet et al; KI, 1985 80% survival-primary ARF all RRT • Zobel et al; Ped Neph, 1989 65% survival-CRRT • Zobel et al; Contrib Neph, 1991 60% survival-CAVH, 35%-survival- CVVH bunchman

Pediatric ARF Single RRT Modality • Paret et al; J Thor Cardiovas Surg , 1992 33% survival-CAVH • Gallego et al; Nephron, 1993 52% survival with PD/HD features of poorer prognosis –less then 1 mos of age –hypotension bunchman

Pediatric ARF Single RRT Modality • Bradbury et al; Arch Dis Child, 1994 33% survival-CVVH • Latta et al; Ped Neph, 1994 37% survival-CAVH • Smoyer et al; JASN, 1995 43% survival-CRRT bunchman

Pediatric ARF Comparison of RRT modalities • Fleming et al; J Thor Cardiovas Surg, 1995 38% survival-PD 33% survival-CAVH 42% survival-CVVH • Maxvold et al; Am J Kid Dis, 1997 43% survival-CVVH 83% survival-HD bunchman

Pediatric ARF Comparison of RRT modalities • Lowrie et al; Ped Neph, 2000 – evaluation of PD vs CVVHF in children with MOSF – survival equal but related to disease state and the number of organs non functioning bunchman

Adult ARF Comparison of RRT modalities • Kruczynski et al; ASAIO, 1993 75% Survival-CAVH; 18% survival-HD • Bellomo et al; ASAIO, 1993 40% Survival-CRRT; 30% survival-HD • van Brommel et al: Am J Neph, 1995 43% Survival-CRRT; 59% survival-HD bunchman

New Dialysis Patients 1992 -1998 (total 354) bunchman

Demographics bunchman

Modality of Choice at onset bunchman

Diagnosis bunchman

ARF-282 patients • Time on therapy – HF-8. 7 days – HD-9. 5 days – PD-9. 6 days NS • Heparin Free Therapies – HF-51% – HD-28% bunchman < 0. 01

Survivors: Analysis by weight bunchman

Survivors: Analysis by BP at onset bunchman

Survivors: Analysis by use of Pressors bunchman

Survivors: Analysis by RRT modality bunchman

Survivors: Analysis by RRT modality and weight bunchman

Survivors: Analysis by Diagnosis and RRT Modality bunchman

Analysis by Diagnosis RRT Modality and Pressors bunchman

Survivors: Analysis by Diagnosis and RRT Modality bunchman

Analysis by Diagnosis RRT Modality and Pressors bunchman

Survivors: Analysis by Diagnosis and RRT Modality bunchman

Analysis by Diagnosis RRT Modality and Pressors bunchman

RRT for ARF • Best RRT is one that’s continuous, done with ease, and minimizes risk of hypotension, access complications, infectious risk, or coagulation risk • Best local standard is the best modality • Nutritional needs of the child need to be factored in and adjusted for RRT modality bunchman

RRT for ARF • Survival is related to diagnosis, hypotension, use of pressor agents and PRISM scores and may be influenced by RRT choice • ARF management needs to be a cooperative effort between Nephrologists and Intensivists for the optimal care of children bunchman