Renal replacement therapy (RRT) is a critical intervention for pediatric patients with acute kidney injury (AKI) or end-stage renal disease (ESRD). The modalities and management strategies differ significantly from those in adults due to the unique physiological and developmental considerations in children.
Key Points in Pediatric RRT:
- Modalities of RRT in Pediatrics:
- Hemodialysis (HD): Common in older children, requiring vascular access and specialized pediatric dialysis machines.
- Peritoneal Dialysis (PD): Often preferred for younger children and neonates due to ease of use and fewer hemodynamic complications.
- Continuous Renal Replacement Therapy (CRRT): Suitable for critically ill children in intensive care settings.
- Indications:
- Severe fluid overload unresponsive to diuretics.
- Refractory hyperkalemia or metabolic acidosis.
- Uremic symptoms (e.g., encephalopathy or pericarditis).
- Toxic substance clearance in specific poisonings.
- Challenges in Pediatric RRT:
- Limited vascular access in small children.
- Adjusting dialysis prescriptions to account for growth, nutritional needs, and metabolic demands.
- Prevention of long-term complications like growth retardation and cognitive impairment.
- Nutritional and Psychosocial Considerations:
- Ensuring adequate caloric intake and growth monitoring.
- Support for family coping and adherence to treatment.
- Advances in Pediatric RRT:
- Miniaturized CRRT machines tailored for neonates.
- Innovative biomaterials to improve biocompatibility and reduce infection risk.
