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Complications of continuous renal replacement therapy in critically ill children: a prospective observational evaluation study.

Santiago MJ, López-Herce J, Urbano J, Solana MJ, del Castillo J, Ballestero Y, Botrán M, Bellón JM - Crit Care (2009)

Bottom Line: The purpose of this study was to analyze the complications of CRRT in children and to study the associated risk factors.Hypotension was not associated with any patient or CRRT characteristics.The sodium, chloride, and phosphate levels fell during the first 72 hours of CRRT; the changes in electrolyte levels during the course of treatment were not found to be related to any of the variables analyzed, nor were they associated with mortality.

View Article: PubMed Central - HTML - PubMed

Affiliation: Pediatric Intensive Care Service, Hospital General Universitario Gregorio Marañón, Dr Castelo Madrid, 28009, Spain. macosantiago77@yahoo.es

ABSTRACT

Introduction: Continuous renal replacement therapy (CRRT) frequently gives rise to complications in critically ill children. However, no studies have analyzed these complications prospectively. The purpose of this study was to analyze the complications of CRRT in children and to study the associated risk factors.

Methods: A prospective, single-centre, observational study was performed in all critically ill children treated using CRRT in order to determine the incidence of complications related to the technique (problems of catheterization, hypotension at the time of connection to the CRRT, hemorrhage, electrolyte disturbances) and their relationship with patient characteristics, clinical severity, need for vasoactive drugs and mechanical ventilation, and the characteristics of the filtration techniques.

Results: Of 174 children treated with CRRT, 13 (7.4%) presented problems of venous catheterization; this complication was significantly more common in children under 12 months of age and in those weighing less than 10 kg. Hypotension on connection to CRRT was detected in 53 patients (30.4%). Hypotension was not associated with any patient or CRRT characteristics. Clinically significant hemorrhage occurred in 18 patients (10.3%); this complication was not related to any of the variables studied. The sodium, chloride, and phosphate levels fell during the first 72 hours of CRRT; the changes in electrolyte levels during the course of treatment were not found to be related to any of the variables analyzed, nor were they associated with mortality.

Conclusions: CRRT-related complications are common in children and some are potentially serious. The most common are hypotension at the time of connection and electrolyte disturbances. Strict control and continuous monitoring of the technique are therefore necessary in children on CRRT.

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Evolution of potassium, calcium, phosphorus and magnesium serum levels during the first 72 hours of continuous renal replacement therapy. Mean and standard deviation.
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Figure 2: Evolution of potassium, calcium, phosphorus and magnesium serum levels during the first 72 hours of continuous renal replacement therapy. Mean and standard deviation.

Mentions: The changes in the electrolyte levels (sodium, potassium, chloride, calcium, phosphorus, and magnesium) over the first 72 hours of CRRT are shown in Figures 1 and 2. In the first 72 hours of CRRT, the levels of sodium, chloride, and phosphate fell significantly, total calcium increased significantly, and the levels of potassium and magnesium remained unaltered. Figures 3 and 4 show the percentage of electrolyte disturbances during the first three days of CRRT. The percentage of patients with raised electrolyte levels decreased progressively during the first three days of therapy (Figure 3). In contrast, the percentage of patients with hyponatremia, hypochloremia, and hypophosphatemia increased significantly during CRRT, requiring an increase in the concentration of these electrolytes in the dialysis and replacement fluids and/or intravenous supplements (Figure 4). The electrolyte disturbances did not lead to clinical manifestations except in one patient in whom Dialisan AFB (Hospal®, Barcelona, Spain) was used as the dialysis fluid. This fluid has a sodium concentration of 4725 mEq/L and requires dilution of 1 mL in 35 mL of water before use; in error, the solution was used undiluted for a few hours and the patient presented hypernatremia of 216 mEq/L, hyperchloremia of 189 mEq/L, and ionic calcium of 4 mmol/L, leading to hypertension and a convulsive crisis. The electrolyte disturbances were corrected by substitution of the dialysis fluid (by a specific CRRT dialysis fluid) [12]; after correction, the patient presented a good clinical course and there have been no neurological or renal sequelae after nine years of follow-up.


Complications of continuous renal replacement therapy in critically ill children: a prospective observational evaluation study.

Santiago MJ, López-Herce J, Urbano J, Solana MJ, del Castillo J, Ballestero Y, Botrán M, Bellón JM - Crit Care (2009)

Evolution of potassium, calcium, phosphorus and magnesium serum levels during the first 72 hours of continuous renal replacement therapy. Mean and standard deviation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2811926&req=5

Figure 2: Evolution of potassium, calcium, phosphorus and magnesium serum levels during the first 72 hours of continuous renal replacement therapy. Mean and standard deviation.
Mentions: The changes in the electrolyte levels (sodium, potassium, chloride, calcium, phosphorus, and magnesium) over the first 72 hours of CRRT are shown in Figures 1 and 2. In the first 72 hours of CRRT, the levels of sodium, chloride, and phosphate fell significantly, total calcium increased significantly, and the levels of potassium and magnesium remained unaltered. Figures 3 and 4 show the percentage of electrolyte disturbances during the first three days of CRRT. The percentage of patients with raised electrolyte levels decreased progressively during the first three days of therapy (Figure 3). In contrast, the percentage of patients with hyponatremia, hypochloremia, and hypophosphatemia increased significantly during CRRT, requiring an increase in the concentration of these electrolytes in the dialysis and replacement fluids and/or intravenous supplements (Figure 4). The electrolyte disturbances did not lead to clinical manifestations except in one patient in whom Dialisan AFB (Hospal®, Barcelona, Spain) was used as the dialysis fluid. This fluid has a sodium concentration of 4725 mEq/L and requires dilution of 1 mL in 35 mL of water before use; in error, the solution was used undiluted for a few hours and the patient presented hypernatremia of 216 mEq/L, hyperchloremia of 189 mEq/L, and ionic calcium of 4 mmol/L, leading to hypertension and a convulsive crisis. The electrolyte disturbances were corrected by substitution of the dialysis fluid (by a specific CRRT dialysis fluid) [12]; after correction, the patient presented a good clinical course and there have been no neurological or renal sequelae after nine years of follow-up.

Bottom Line: The purpose of this study was to analyze the complications of CRRT in children and to study the associated risk factors.Hypotension was not associated with any patient or CRRT characteristics.The sodium, chloride, and phosphate levels fell during the first 72 hours of CRRT; the changes in electrolyte levels during the course of treatment were not found to be related to any of the variables analyzed, nor were they associated with mortality.

View Article: PubMed Central - HTML - PubMed

Affiliation: Pediatric Intensive Care Service, Hospital General Universitario Gregorio Marañón, Dr Castelo Madrid, 28009, Spain. macosantiago77@yahoo.es

ABSTRACT

Introduction: Continuous renal replacement therapy (CRRT) frequently gives rise to complications in critically ill children. However, no studies have analyzed these complications prospectively. The purpose of this study was to analyze the complications of CRRT in children and to study the associated risk factors.

Methods: A prospective, single-centre, observational study was performed in all critically ill children treated using CRRT in order to determine the incidence of complications related to the technique (problems of catheterization, hypotension at the time of connection to the CRRT, hemorrhage, electrolyte disturbances) and their relationship with patient characteristics, clinical severity, need for vasoactive drugs and mechanical ventilation, and the characteristics of the filtration techniques.

Results: Of 174 children treated with CRRT, 13 (7.4%) presented problems of venous catheterization; this complication was significantly more common in children under 12 months of age and in those weighing less than 10 kg. Hypotension on connection to CRRT was detected in 53 patients (30.4%). Hypotension was not associated with any patient or CRRT characteristics. Clinically significant hemorrhage occurred in 18 patients (10.3%); this complication was not related to any of the variables studied. The sodium, chloride, and phosphate levels fell during the first 72 hours of CRRT; the changes in electrolyte levels during the course of treatment were not found to be related to any of the variables analyzed, nor were they associated with mortality.

Conclusions: CRRT-related complications are common in children and some are potentially serious. The most common are hypotension at the time of connection and electrolyte disturbances. Strict control and continuous monitoring of the technique are therefore necessary in children on CRRT.

Show MeSH
Related in: MedlinePlus