Epuration extra-rénale en réanimation pédiatrique : mise au point et éléments pratiques

Epuration extra-rénale en réanimation pédiatrique

Abstract

Acute renal injury (AKI) is a frequent complication in paediatric intensive care, requiring kidney replacement therapy (KRT) in around 4%. It warrants rapid transfer to a center with expertise in CKRT, as worsening AKI and fluid overload have been associated with increased mortality. The main indications in pediatrics are acute renal failure (ARF) and fluid overload, as well as non-renal indications such as the removal of toxic metabolites in inborn errors of metabolism, acute liver failure and certain intoxications. A multidisciplinary approach involving pediatric intensivists and nephrologists, together with a regularly trained paramedical team, guarantee the safety and high performance of the various KRT techniques. To date, there is little specific equipment for the paediatric population, especially for newborns. Continuous kidney replacement therapy (CKRT) is the preferred method for critically ill and hemodynamically unstable children, as it enables gentle elimination of fluids and solutes. Intermittent hemodialysis and peritoneal dialysis remain satisfactory alternatives. Proper follow-up of these children is essential, as they are at increased risk of long-term complications.