Continuous renal replacement therapy for acute renal failure in children with malignancies

Abstract

 Although a long-term prognosis of children with malignancies has improved by the advances in medicine, these patients occasionally develop acute renal failure (ARF) requiring continuous renal replacement therapy (CRRT) during the course of a disease. We retrospectively assessed the clinical course of 15 patients (mean age 8.7 years) treated with CRRT. Of the 15 patients, 10 survived an initial ARF episode. However, remaining 5 patients died during CRRT. In order to clarify the factors associated with increased mortality, the clinical characteristics of both survivors and non-survivors were analysed. Age at the start of CRRT, body weight, duration of CRRT, urinary volume before CRRT, glomerular filtration rate, hemoglobin and platelets counts did not correlate with survival. We found lager number of organ failure (p<0.01), presence of sepsis (p<0.05) and lower white blood cell counts (p<0.05) were significantly associated with greater mortality. The development of pump-driven volumetric-control CRRT machines with small extra corporeal volumes has lead to the safety use of CRRT even in children with hemodynamic instability. Our data suggest that patients with ARF in multiple organ failure due to sepsis under leukopenia have a high probability of death.