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International Journal of Nephrology
Volume 2011, Article ID 785392, 8 pages
http://dx.doi.org/10.4061/2011/785392
Research Article

Acute Renal Replacement Therapy in Pediatrics

1Division of Critical Care and Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
2Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA
3Division of Nephrology and Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA

Received 14 February 2011; Accepted 4 April 2011

Academic Editor: Michel Fischbach

Copyright © 2011 Rajit K. Basu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Acute kidney injury (AKI) independently increases morbidity and mortality in children admitted to the hospital. Renal replacement therapy (RRT) is an essential therapy in the setting of AKI and fluid overload. The decision to initiate RRT is complex and often complicated by concerns related to patient hemodynamic and thermodynamic instability. The choice of which RRT modality to use depends on numerous criteria that are both patient and treatment center specific. Surprisingly, despite decades of use, no randomized, controlled trial study involving RRT in pediatrics has been performed. Because of these factors, clear-cut consensus is lacking regarding key questions surrounding RRT delivery. In this paper, we will summarize existing data concerning RRT use in children. We discuss the major modalities and the data-driven specifics of each, followed by controversies in RRT. As no standard of care is in widespread use for RRT in AKI or in multiorgan disease, we conclude in this paper that prospective studies of RRT are needed to identify best practice guidelines.