신생아와 소아의 지속적 신대체요법(CRRT) 적용 특성 및 결과

Clinical Differences and Outcomes of Continuous Renal Replacement Therapy between Critically Ill Neonates and Children

  • 최앵자 (삼성서울병원) ;
  • 최수정 (삼성서울병원 뇌신경센터, 성균관대학교 임상간호대학원) ;
  • 최희정 (삼성서울병원) ;
  • 유미영 (삼성서울병원)
  • Choi, Aeng Ja (Intensive Care Unit, Samsung Medical Center) ;
  • Choi, Su Jung (Brain-Nerve Center, Samsung Medical Center, Graduate School of Clinical Nursing Science, Sungkyunkwan University) ;
  • Choi, Hee Jung (Intensive Care Unit, Samsung Medical Center) ;
  • You, Mi Young (Intensive Care Unit, Samsung Medical Center)
  • 투고 : 2016.05.27
  • 심사 : 2016.06.23
  • 발행 : 2016.06.30

초록

Purpose: Continuous renal replacement therapy (CRRT) has become the preferred dialysis method to support critically ill children and neonates with acute kidney injury. Using CRRT on neonates has increased, but reports about experience are limited. The aim of this study is to describe the clinical application, outcomes, and complications of CRRT in children and neonates. Methods: A retrospective review was performed in 135 children and 36 neonates who underwent CRRT at a tertiary hospital from 2008 to 2015. Results: At the initiation of CRRT, the median age of children was 72 months and the corrected age of neonates was 37.1 weeks. Median body weight of neonates was 3.2 kg. In neonates, initial degree of fluid overload [FO%], blood flow rate [BFR] and ultrafiltration rate [UFR] rate during CRRT were higher than in children. Median real time of CRRT was 90.5 and 53.5 hours in children and neonates, respectively. Downtime of CRRT was 0.7 and 1.3 hours/day. Median mortality rates (44.4% vs.47.2%) and complication rates were similar between the groups. Conclusion: CRRT can be used for a wide range of critically ill children and neonates. Different application methods of CRRT can contribute to increased survival of neonates.

키워드

참고문헌

  1. Ahn, Y., Sohn, M., & Lee, S. (2011). Growth patterns of premature infants up to 40th term week of corrected age. Journal of Korean Academy of Nursing, 41(5), 613-622. https://doi.org/10.4040/jkan.2011.41.5.613
  2. Askenazi, D. J., Goldstein, S. L., Koralkar, R., Fortenberry, J., Baum, M., Hackbarth, R., et al. (2013). Continuous renal replacement therapy for children ${\leq}10kg$: A report from the prospective pediatric continuous renal replacement therapy registry. Journal of Pediatrics, 162(3), 587-592 https://doi.org/10.1016/j.jpeds.2012.08.044
  3. Choi, Y. Y. (2008). Management of premature and low birth weight infants. Journal of Korean Medical Association, 51(8), 745-754 https://doi.org/10.5124/jkma.2008.51.8.745
  4. Fealy, N., Baldwin, I., & Bellomo, R. (2002). The effect of circuit "down-time" on uraemic control during continuous venovenous haemofiltration. Critical Care Resuscuscitation, 4(4), 266-270.
  5. Goldstein, S. L. (2011). Advances in pediatric renal replacement therapy for acute kidney injury. Seminars in Dialysis, 24(2), 187-191. https://doi.org/10.1111/j.1525-139X.2011.00834.x
  6. Hahn, H., & Park, Y. S. (2004). Continuous renal replacement therapy in pediatrics. Korean Journal of Pediatrics, 47(1), 1-5.
  7. Hayes, L. W., Oster, R. A., Tofil, N. M., & Tolwani, A. J. (2009). Outcomes of critically ill children requiring continuous renal replacement therapy. Journal of Critical Care, 24(3), 394-400. https://doi.org/10.1016/j.jcrc.2008.12.017
  8. Hiroma, T., Nakamura, T., Tamura, M., Kaneko, T., & Komyyama, A. (2002). Continuous venovenous hemodiafiltration in neonatal onset hyperammonemia. American Journal of Perinatology, 19(4), 221-224. https://doi.org/10.1055/s-2002-28487
  9. Kim, E. Y., Lee, Y., Lee, S. M., Choi, M., Song, Y. R., Kim, S. J., et al. (2011). Low-dose nafamostat mesilate in hemodialysis patients at high bleeding risk. The Korean Journal of Nephrology, 30(1), 61-66.
  10. Kim, S. H., & Shin, J. I. (2014). Continuous renal replacement therapy in infants and neonates. Journal of the Korean Society of Pediatric Nephrology, 18(1), 13-17. https://doi.org/10.3339/jkspn.2014.18.1.13
  11. Kim, S. Y. (2010). Acute kidney injury in the newborn: etiology, pathophysiology and diagnosis. Journal of the Korean Society of Neonatology, 17(2), 161-167. https://doi.org/10.5385/jksn.2010.17.2.161
  12. Lee, B. S. (2013). Continuous renal replacement therapy in neonates. Neonatal Medicine, 20(1), 12-19. https://doi.org/10.5385/nm.2013.20.1.12
  13. Lee, J. A. (2010). Treatment of acute renal failure in neonate. Journal of Korean Society of Neonatology, 17(2), 168-180. https://doi.org/10.5385/jksn.2010.17.2.168
  14. Lee, S. J., Park, H. S., Im, E. Y., & Sim, Y. M. (2007). The warming method to prevent from hypothermia in patients taking CRRT(Continuous renal replacement therapy). Journal of the Korean Society of Pediatric Nephrology, 13(3), 69-80.
  15. Paik, K. H. (2007). Renal replacement therapy in children with acute renal failure. Korean Journal of Pediatrics, 50(10), 938-947. https://doi.org/10.3345/kjp.2007.50.10.938
  16. Park, J. (2009). Continuous renal replacement therapy in children. Journal of the Korean Society of Pediatric Nephrology, 13(2), 118-129. https://doi.org/10.3339/jkspn.2009.13.2.118
  17. Ricci, Z., Guzzo, I., Picca, S., & Picardo, S. (2008). Circuit lifespan during continuous renal replacement therapy: children and adults are not equal. Critical Care, 12(5), 178. https://doi.org/10.1186/cc7000
  18. Richardson, A., & Whatmore, J. (2015). Nursing essential principles: continuous renal replacement therapy. Nursing in Critical Care, 20(1), 8-15. https://doi.org/10.1111/nicc.12120
  19. Rickard, C. M., Couchman, B. A., Hughes, M., & McGrail, M. R. (2004). Preventing hypothermia during continuous venovenous haemodiafiltration: a randomized controlled trial. Journal of Advanced Nursing, 47(4), 393-400. https://doi.org/10.1111/j.1365-2648.2004.03117.x
  20. Ronco, C., Garzotto, F., & Ricci, Z. (2012). CA.R.PE.DI.E.M. (Cardio-Renal Pediatric Dialysis Emergency Machine): evolution of continuous renal replacement therapies in infants. A personal journey. Pediatric Nephrololgy, 27(8), 1203-1211. https://doi.org/10.1007/s00467-012-2179-8
  21. Santiago, M. J., Lopez-Herce, J., Urbano, J., Solana, M. J., del Castillo, J., Ballestero, Y., et al. (2009). Complications of continuous renal replacement therapy in critically ill children: a prospective observational evaluation study. Critical Care, 13(6), R184. https://doi.org/10.1186/cc8172
  22. Santiago, M. J., Lopez-Herce, J., Urbano, J., Solana, M. J., del Castillo, J., Ballestero, Y., et al. (2010). Clinical course and mortality risk factors in critically ill children requiring continuous renal replacement therapy. Intensive Care Medicine, 36(5), 843-849. https://doi.org/10.1007/s00134-010-1858-9
  23. Sohn, Y. B., Paik, K. H., Cho, H. Y., Kim, S. J., Park, S. W., Kim, E. S., et al. (2012). Continuous renal replacement therapy in neonates weighing less than 3 kg. Korean Journal of Pediatrics, 55(8), 286-292. https://doi.org/10.3345/kjp.2012.55.8.286
  24. Sutherland, S. M., Ji, J., Sheikhi, F. H., Widen, E., Tian, L., Alexander, S. R., et al. (2013). AKI in hospitalized children: epidemiology and clinical associations in a national cohort. Clinical Journal of Amrican Society of Nephrology, 8(10), 1661-1669. doi:10.2215/CJN.00270113.
  25. Sutherland, S. M., Zappitelli, M., Alexander, S. R., Chua, A. N., Brophy, P. D., Bunchman, T. E., et al. (2010). Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. American Journal of Kidney Disease, 55(2), 316-325. https://doi.org/10.1053/j.ajkd.2009.10.048
  26. Symons, J. M., Brophy, P. D., Gregory, M. J., McAfee, N., Somers, M. J. G., Bunchman, T. E., et al. (2003). Continuous renal replacement therapy in children up to 10 kg. American Journal of Kidney Diseases, 41(5), 984-989. https://doi.org/10.1016/S0272-6386(03)00195-1
  27. Symons, J. M., Chua, A. N., Somers, M. J., Baum, M. A., Bunchman, T. E., Benfield, M. R., et al. (2007). Demographic characteristics of pediatric continuous renal replacement therapy: a report of the prospective pediatric continuous renal replacement therapy registry. Clinical Journal of American Society of Nephrology, 2(4), 732-738. https://doi.org/10.2215/CJN.03200906
  28. Vijayan, A. (2009). Vascular access for continuous renal replacement therapy. Seminars in Dialysis, 22(2), 133-136. https://doi.org/10.1111/j.1525-139X.2008.00553.x
  29. Warady, B. A., Schaefer, F. S., & Alexander, S. R. (Eds.). (2004). Pediatric dialysis. Netherlands: Springer.
  30. Westrope, C., Morris, K., Burford, D., & Morrison, G. (2010). Continuous hemofiltration in the control of neonatal hyperammonemia: a 10-year experience. Pediatric Nephrology, 25(9), 1725-1730. doi: 10.1007/s00467-010-1549-3.