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Merkezimizdeki Pediatrik Akut Diyaliz Deneyimleri

A Recent Experience About Pediatric Acute Dialysis in our Center

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2010
DOI: 
doi: 10.5262/tndt.2010.1002.67

Key Words:

Keywords (Original Language):

Author NameUniversity of Author
Abstract (2. Language): 
Acute reOBJECTIVE: Acute renal failure is a life-threatening event in critically ill children. The dialysis modality depends on the clinical status of the patient and technical opportunities. We aimed to assess the renal replacement therapies (RRT) performed in children admitted to our center in a four-year period. MATERIAL and METHODS: We retrospectively evaluated the data of children who received RRT in intensive care units in our center between January 2004 and September 2007. The anthropometric values, etiological factors, dialysis details, laboratory fi ndings, medications, involvement of organs or systems other than kidneys and outcome of the patients were recorded. RESULTS: There were 18 children (M/F:11/7) meeting the criteria aged between 3 days and 17 years. Seven of the patients were premature and three of them were very low-birth-weight infants Two patients received continuous hemodiafi ltration, two received intermittent hemodialysis and the rest of them received peritoneal dialysis. The most frequent cause for RRT was increased serum creatinine levels. The mean duration of care in ICU before RRT initiation was 6.67±5.01 (0-18) days. The mean duration of continuous RRT in patients except the two who received intermittent hemodialysis was 154.31±102.29 (40-396) hours. The mortality rate was 83% (15/18) and the three survivors received short-term peritoneal dialysis, one of whom additionally received intermittent hemodialysis due to vancomycin toxicity. Two of them needed no pressors. Each patient had complications associated with the type of dialysis modality and catheters, but none solely leaded to mortality. All three very low-birthweight infants received peritoneal dialysis via peripheral venous catheters. CONCLUSIONS: Peritoneal dialysis is still an encouraging, simply performed RRT modality for acute renal failure, especially in small children. It is even accessible in very low-birth-weight infants through simple catheters. Sharing latest clinical experiences may encourage its use when other techniques are not available.nal failure, Renal replacement therapy, Children Intensive care, Renal failure
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Abstract (Original Language): 
AMAÇ: Akut böbrek yetmezliği yoğun bakım hastalarında hayatı tehdit eden bir problemdir. Tercih edilecek diyaliz biçimi, hastanın klinik durumu ve teknik imkanlara bağlıdır. Bu çalışmada dört yıllık periyodda merkezimizde çocuklara uygulanan akut renal replasman tedavileri (RRT) değerlendirilmiştir. GEREÇ ve YÖNTEMLER: Ocak 2004–Eylül 2007 tarihleri arasında Merkezimizde akut RRT alan çocukların verileri retrospektif olarak değerlendirildi. Antropometrik değerler, etiyolojik faktörler, diyaliz ile ilgili detaylar, laboratuvar bulguları, ilaç tedavileri, diğer organ tutulumları ve hastaların izlem sonuçları kaydedildi. BULGULAR: Kriterlere uyan 3 gün–17 yaş arasında 18 hasta (E/K:11/7) mevcut idi. Hastaların yedisi prematüre ve üçü çok düşük doğum ağırlıklı idi. İki hastaya devamlı hemodiyafi ltrasyon, iki hastaya aralıklı hemodiyaliz ve geri kalan hastalara periton diyalizi uygulanmıştı. RRT gerektiren en sık neden serum kreatinin değerlerinin artması idi. Hastaların RRT öncesi yoğun bakımda kalış süreleri 6,67±5,01 (0-18) gün idi. Aralıklı hemodiyaliz alan iki hasta dışındaki hastaların devamlı RRT alım süreleri 154,31±102,29 (40-396) saat idi. Mortalite oranı %83 (15/18) olup, sağ kalan üç hasta kısa süreli periton diyalizine alınmış, ikisinin pressör ihtiyacı olmamıştı. Bu hastalardan biri vankomisin aşırı dozu nedeni ile periton diyalizine ek olarak hemodiyalize alınmıştı. Tüm hastalarda diyaliz tipi ya da kateter ile ilgili problem yaşanmış olup bunların hiçbiri mortaliteye neden olmamıştı. Periton diyalizi düşük doğum ağırlıklı bebeklerin tümüne periferik venöz kateterler yolu ile uygulanmıştı. SONUÇ: Periton diyalizi özellikle küçük çocuklarda halen akut böbrek yetmezliğinde sıkça ve kolaylıkla uygulanabilen bir RRT yöntemidir. Düşük doğum ağırlıklı yenidoğanlarda bile basit kateterler uygulanabilmektedir. Son klinik deneyimler, özellikle diğer tekniklerin kısıtlı olduğu durumlarda periton diyalizi kullanımını vurgulamak amacı ile paylaşılmıştır.
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