Dados do Trabalho

Título

RENAL HOMEOSTASIS IN CRITICALLY ILL CHILDREN WITH CANCER AND MULTIPLE ORGAN DYSFUNCTION SYNDROME: THE ROLE OF CONTINUOUS RENAL REPLACEMENT THERAPY

Introdução

Continuous renal replacement therapy (CRRT) has become the standard for supporting acute renal failure in the pediatric intensive care unit (PICU). Our aim was to evaluate its role in restoring homeostasis in severely ill children with cancer.

Material e Método

cohort of patients with multiple organ dysfunction syndrome (MODS) who received CRRT in the onco-PICU of a referral hospital. We compared measurements the day of starting CRRT and after 72 hours with the paired T-test.

Resultados

We analyzed 59 cases. Leukemias and lymphomas accounted for 44% of cases, and 30% received haematopoietic stream cell transplantation (HSCT). Median age was 10.1 y. The 30-days mortality was 44%. Median duration of CRRT was 9 days (IQR 4.5-15). The most frequent causes of PICU admission were sepsis (20%) and acute respiratory failure (41%). Fluid overload was present in 51%; the mean classification of acute kidney injury - KDIGO was 2 (SD:1). 59.3% required inotropes and 79.7% mechanical ventilation. For the lab tests on the day of initiation and after 72 hours of CRRT, we observed differences in mean pH (7.30 vs. 7.36, p = 0.02); base excess (-5.1 vs. -2.4, p = 0.001); bicarbonate (20.9 vs. 24.4, p = 0.009), urea (89.3 vs. 68.9, p <0.001), creatinine (1.6 vs. 0.9, p <0.001), phosphorus (5.5 vs. 3.8, p = 0.005), and albumin (3.2 vs. 3.5, p = 0.01). The mean cumulative fluid balance in the 72 hours before CRRT was 94 mL/kg, and after 72 hours was -14.8 mL/kg (p < 0.0001).

Discussão e Conclusões

In these critically ill patients, CRRT promotes rapid improvement in fluid balance, metabolic acidosis, and in nitrogenous end products of metabolism.

Palavras Chave

CONTINUOUS RENAL REPLACEMENT THERAPY , pediatric intensive care unit, severely ill children with cancer