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

bunchman Infant ARF Single RRT Modality Ronco et al; Intens Care Med, % 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, % survival-primary ARF all RRT Zobel et al; Ped Neph, % survival-CRRT Zobel et al; Contrib Neph, % survival-CAVH, 35%-survival- CVVH

bunchman Pediatric ARF Single RRT Modality Paret et al; J Thor Cardiovas Surg, % survival-CAVH Gallego et al; Nephron, % 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, % survival-CVVH Latta et al; Ped Neph, % survival-CAVH Smoyer et al; JASN, % survival-CRRT

bunchman Pediatric ARF Comparison of RRT modalities Fleming et al; J Thor Cardiovas Surg, % survival-PD 33% survival-CAVH 42% survival-CVVH Maxvold et al; Am J Kid Dis, % 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, % Survival-CAVH; 18% survival-HD Bellomo et al; ASAIO, % Survival-CRRT; 30% survival-HD van Brommel et al: Am J Neph, % Survival-CRRT; 59% survival-HD

bunchman New Dialysis Patients (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 daysNS Heparin Free Therapies –HF-51% –HD-28%< 0.01

bunchman 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 thats 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 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 RRT for ARF