Continuous Renal Replacement Therapy in Children Post-Hematopoietic Stem Cell Transplantation: The Present and the Future
R. Ray Morrison.
Allogeneic hematopoietic stem cell transplantation (HSCT) use has expanded markedly to treat different disorders
like hematologic malignancies, immunodeficiency, and inborn errors of metabolism. However, it is commonly associated
with complications that limit the benefit of this therapy. Acute renal failure occurs commonly after HSCT and results
in increased risk of mortality. In many instances, children post-HSCT develop acute renal insufficiency in the context
of other organ failure, necessitating intensive care unit admission for management. Recently, continuous renal replacement
therapy (CRRT) has emerged as the favored modality of renal replacement therapy in the care of critically ill
children who are hemodynamically unstable. Currently, CRRT is being utilized more often in the care of critically ill post-
HSCT children to treat renal failure or to prevent fluid overload (FO). FO>20% has been shown in many studies to be an
independent risk of mortality in critically ill children and therefore, many clinicians will initiate this therapy due to FO
even without overt renal failure. CRRT may be beneficial in disease processes as acute lung injury due to removal of
fluid. CRRT results in improved oxygenation in post-HSCT children with acute lung injury and this improvement is sustained
for at least 48 hours after initiation of this therapy. Survival in post-HSCT children requiring this therapy ranges
from 17% to 45%, however, long term survival is still poor. This review will discuss current practice of CRRT in children
post-HSCT, as well as future directions.
Keywords: Acute lung injury, critically ill, hematopoietic stem cell transplantation, pediatrics, renal failure, renal replacement therapy, Allogeneic hematopoietic stem cell transplantation (HSCT), Acute kidney injury, continuous renal replacement therapy.
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