Received September 24, 2006
Accepted on March 29, 2007

ORIGINAL ARTICLES

Demographic Characteristics of Pediatric Continuous Renal Replacement Therapy: A Report of the Prospective Pediatric Continuous Renal Replacement Therapy Registry

Jordan M. Symons ^*1, Annabelle N. Chua , Michael J.G. Somers , Michelle A. Baum , Timothy E. Bunchman , Mark R. Benfield ^||, Patrick D. Brophy ^¶, Douglas Blowey ^**, James D. Fortenberry , Deepa Chand , Francisco X. Flores , Richard Hackbarth , Steven R. Alexander ^||||, John Mahan ^¶¶, Kevin D. McBryde ^***, and Stuart L. Goldstein

*Department of Pediatrics, University of Washington School of Medicine and Children’s Hospital & Regional Medical Center, Seattle, Washington; Department of Pediatrics, Renal Section, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas; Department of Pediatrics, Division of Nephrology, Harvard Medical School and Children’s Hospital, Boston, Massachusetts; Department of Pediatrics and Human Development, Michigan State University and DeVos Children’s Hospital, Grand Rapids, Michigan; ||Department of Pediatrics, Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama; ¶Department of Pediatrics, Division of Nephrology, University of Michigan and C.S. Mott Children’s Hospital, Ann Arbor, Michigan; **Department of Pediatric Nephrology, Children’s Mercy Hospital and Clinics, Kansas City, Missouri; Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta at Egleston, Atlanta, Georgia; Section of Pediatric Nephrology, the Children’s Hospital at the Cleveland Clinic, Cleveland, Ohio; Department of Pediatrics, Division Pediatric Nephrology, University of South Florida College of Medicine and All Children’s Hospital, St. Petersburg, Florida; ||||Department of Pediatrics, Stanford School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, California; ¶¶Department of Pediatrics, Ohio State University College of Medicine and Public Health and Columbus Children’s Hospital, Columbus, Ohio; and ***Department of Nephrology, Children’s National Medical Center, Washington, DC

¹ To whom correspondence should be addressed. E-mail: jordan.symons{at}seattlechildrens.org.

	Abstract

We report demographic characteristics and intensive care unit survival for 344 patients from the Prospective Pediatric Continuous Renal Replacement Therapy (ppCRRT) Registry, a voluntary multicenter observational network. Ages were newborn to 25 yr, 58% were male, and weights were 1.3 to 160 kg. Patients spent a median of 2 d in the intensive care unit before CRRT (range 0 to 135). At CRRT initiation, 48% received diuretics and 66% received vasoactive drugs. Mean blood flow was 97.9 ml/min (range 10 to 350 ml/min; median 100 ml/min); mean blood flow per body weight was 5 ml/min per kg (range 0.6 to 53.6 ml/min per kg; median 4.1 ml/min per kg). Days on CRRT were <1 to 83 (mean 9.1; median 6). A total of 56% of circuits had citrate anticoagulation, 37% had heparin, and 7% had no anticoagulation. Overall survival was 58%; survival differed across participating centers. Survival was lowest (51%) when CRRT was started for combined fluid overload and electrolyte imbalance. There was better survival in patients with principal diagnoses of drug intoxication (100%), renal disease (84%), tumor lysis syndrome (83%), and inborn errors of metabolism (73%); survival was lowest in liver disease/transplant (31%), pulmonary disease/transplant (45%), and bone marrow transplant (45%). Overall survival was better for children who weighed >10 kg (63 versus 43%; P = 0.001) and for those who were older than 1 yr (62 versus 44%; P = 0.007). It is concluded that CRRT can be used successfully for a wide range of critically ill children. Survival is best for those who have acute, specific abnormalities and lack multiple organ involvement; sicker patients with selected diagnoses may have lower survival. Center differences might suggest opportunities to define best practices with future study.