Study Examines Current Practices and Develops Consensus for Best Practices of Continuous Kidney Replacement Therapy in Pediatric Patients

UPMC Children’s Division of Pediatric Nephrology researcher Dana Y. Fuhrman, DO, MS, was the lead author of a study published in Pediatric Nephrology that was designed to identify the current practices in pediatric continuous kidney replacement therapy (CKRT) and to develop a consensus on the best practices for its use and future areas of inquiry that may lead to further refinements or improvements of the use of this therapy in children.

Dr. Fuhrman was joined in the study by colleagues Katja M. Gist, DO, MSc, from Cincinnati Children’s Hospital, and Ayse Akcan-Arikan, MD, from Texas Children’s Hospital

Dr. Fuhrman and colleague’s study used a modified Delphi consensus method, which involved an international panel of pediatric nephrologists, intensivists, and advanced practice providers, conducting literature review and multiple rounds of surveys on a wide range of CKRT practices.

The study used a systematic review of the literature of CKRT practices in children for a 10-year period between 2012 and 2022. Of the more than 18,000 articles identified, 172 were included in the final analysis. 147 respondents completed the first round of the survey process and 126 completed the second round.

Dr. Fuhrman states that “the study participants included an exciting newly assembled collaborative of pediatric prescribers of CKRT known as The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK).” This is an international collaborative of pediatric specialists whose mission is to improve short and long-term outcomes of children treated with CKRT.

This review covered such important topics in pediatric CKRT as the timing of initiation and proper dosing, monitoring of electrolyte levels, optimal anticoagulation therapy, vascular access, and fluid removal.

The analysis uncovered significant consensus for 26 of the practice statements outline in the survey. Globally there was uniformity of responses in practices related to initiation of CKRT, fluid removal, the type of anticoagulation therapy used, and CKRT dosing.

However, in the areas of anticoagulation monitoring and quality of treatment, the was less agreement among the expert panel on optimal clinical care parameters.

The clinical implications of these findings are significant. The study highlights the ongoing need for standardization of CKRT practices in pediatric patients, as well as the need for further research to clarify areas of disagreement and to develop evidence-based guidelines for CKRT use in pediatric patients.

Learn more about study and its findings using the reference link below.

Reference

Fuhrman DY, Gist KM, Akcan-Arikan A. Current Practices in Pediatric Continuous Kidney Replacement Therapy: A Systematic Review-Guided Multinational Modified Delphi Consensus Study. Pediatr Nephrol. 2023 Jan 10. Online ahead of print.