Dose Prescription and Delivery in Neonates With Congenital Heart Diseases Treated With Continuous Veno-Venous Hemofiltration

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Abstract

Objectives:

Renal replacement therapy may be required for acute kidney injury treatment in neonates with complex cardiac conditions. Continuous veno-venous hemofiltration is applied safely in this population but no published recommendations for dose prescription in neonates currently exist. The aim of our study was to evaluate the effects of a relatively small dialysis dose on critically ill neonates.

Design:

Retrospective analysis of clinical charts.

Setting:

Pediatric Cardiac ICU.

Patients:

Ten critically ill neonates with severe acute kidney injury were analyzed. The primary indication for continuous veno-venous hemofiltration initiation was severe fluid overload with oligoanuria.

Interventions:

None.

Measurements and Main Results:

The median (range) age and weight were 3 days (1–12 d) and 2.6 kg (2.1–4.2 kg), respectively, whereas the median continuous veno-venous hemofiltration duration was 17 days (3–63 d). Median prescribed blood flow rate, replacement fluid rate, and net ultrafiltration rate were 12 mL/min (9–50 mL/min), 100 mL/hr (40–200 mL/hr), and 20 mL/hr (5–45 mL/hr), respectively. The median effluent-based continuous veno-venous hemofiltration dose was 35 mL/kg/hr (11–66 mL/kg/hr), whereas the median delivered daily Kt/V per session (24 hr) was 0.5 (0.01–1.8). However, for treatment sessions lasting less than or equal to 12 versus greater than or equal to 12 hours per session, the median prescribed effluent dose was 41 (11–66) and 32 (17–60) mL/kg/hr, respectively (p = 0.06), whereas the delivered creatinine daily Kt/V values were 0.3 (0.01–0.9) and 0.9 (0.5–1.8), respectively (p < 0.0001). An inverse correlation was found between delivered daily Kt/V and the blood concentration differences of both creatinine (r = –0.3; p = 0.0093) and urea (r = –0.3; p = 0.0028) measured at the end and the beginning of a 24-hour treatment. The decrease of creatinine concentration was significantly greater during 24-hour treatment sessions with a delivered daily Kt/V greater than 0.9 than during those with daily Kt/V less than 0.9.

Conclusions:

Based on these findings, we propose on a provisional basis the use of daily Kt/V as a measure of continuous renal replacement therapy adequacy for critically ill neonates.

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