Continuous Renal Replacement Therapy for Children ≤10 kg: A Report from the Prospective Pediatric Continuous Renal Replacement Therapy Registry

Objective To report circuit characteristics and survival analysis in children weighing <= 10 kg enrolled in the Prospective Pediatric Continuous Renal Replacement Therapy (ppCRRT) Registry. Study design We conducted prospective cohort analysis of the ppCRRT Registry to: (1) evaluate survival differences in children <= 10 kg compared with other children; (2) determine demographic and clinical differences between surviving and non-surviving children <= 10 kg; and (3) describe continuous renal replacement therapy (CRRT) circuit characteristics differences in children <= 5 kg versus 5-10 kg. Results The ppCRRT enrolled 84 children <= 10 kg between January 2001 and August 2005 from 13 US tertiary centers. Children <= 10 kg had lower survival rates than children >10 kg (36/84 [43%] versus 166/260 [64%]; P < .001). In children <= 10 kg, survivors were more likely to have fewer days in intensive care unit prior to CRRT, lower Pediatric Risk of Mortality 2 scores at intensive care unit admission and lower mean airway pressure (P-aw), higher urine output, and lower percent fluid overload (FO) at CRRT initiation. Adjusted regression analysis revealed that Pediatric Risk ofMortality 2 scores, FO, and decreased urine output were associated with mortality. Compared with circuits from children 5-10 kg at CRRT initiation, circuits from children <= 5 kg more commonly used blood priming for initiation, heparin anticoagulation, and higher blood flows/effluent flows for body weight. Conclusion Mortality is more common in children who are <= 10 kg at the time of CRRT initiation. Like other CRRT populations, urine output and FO at CRRT initiation are independently associated with mortality. CRRT prescription differs in small children. (J Pediatr 2013;162:587-92).