Frontiers in Pediatrics (Feb 2022)
PCRRT Expert Committee ICONIC Position Paper on Prescribing Kidney Replacement Therapy in Critically Sick Children With Acute Liver Failure
- Rupesh Raina,
- Rupesh Raina,
- Sidharth K. Sethi,
- Guido Filler,
- Shina Menon,
- Aliza Mittal,
- Amrit Khooblall,
- Amrit Khooblall,
- Amrit Khooblall,
- Prajit Khooblall,
- Prajit Khooblall,
- Ronith Chakraborty,
- Ronith Chakraborty,
- Ronith Chakraborty,
- Harsha Adnani,
- Nina Vijayvargiya,
- Nina Vijayvargiya,
- Sharon Teo,
- Girish Bhatt,
- Lee Jin Koh,
- Chebl Mourani,
- Marcelo de Sousa Tavares,
- Khalid Alhasan,
- Michael Forbes,
- Maninder Dhaliwal,
- Veena Raghunathan,
- Dieter Broering,
- Azmeri Sultana,
- Giovanni Montini,
- Giovanni Montini,
- Patrick Brophy,
- Mignon McCulloch,
- Timothy Bunchman,
- Hui Kim Yap,
- Hui Kim Yap,
- Rezan Topalglu,
- Maria Díaz-González de Ferris
Affiliations
- Rupesh Raina
- Cleveland Clinic Akron General Medical Center, Akron, OH, United States
- Rupesh Raina
- Department of Nephrology, Akron Children's Hospital, Akron, OH, United States
- Sidharth K. Sethi
- Kidney and Renal Transplant Institute, Medanta, The Medicity Hospital, Gurgaon, India
- Guido Filler
- Division of Paediatric Nephrology, Department of Paediatrics, Western University, London, ON, Canada
- Shina Menon
- Division of Pediatric Nephrology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, United States
- Aliza Mittal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
- Amrit Khooblall
- Cleveland Clinic Akron General Medical Center, Akron, OH, United States
- Amrit Khooblall
- Department of Nephrology, Akron Children's Hospital, Akron, OH, United States
- Amrit Khooblall
- Akron Nephrology Associates, Akron, OH, United States
- Prajit Khooblall
- Akron Nephrology Associates, Akron, OH, United States
- Prajit Khooblall
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, United States
- Ronith Chakraborty
- Cleveland Clinic Akron General Medical Center, Akron, OH, United States
- Ronith Chakraborty
- Department of Nephrology, Akron Children's Hospital, Akron, OH, United States
- Ronith Chakraborty
- Akron Nephrology Associates, Akron, OH, United States
- Harsha Adnani
- Anne Arundel Medical Center, Annapolis, MD, United States
- Nina Vijayvargiya
- Cleveland Clinic Akron General Medical Center, Akron, OH, United States
- Nina Vijayvargiya
- Akron Nephrology Associates, Akron, OH, United States
- Sharon Teo
- 0Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
- Girish Bhatt
- 1Department of Pediatrics, ISN-SRC, Pediatric Nephrology, All India Institute of Medical Sciences (AIIMS), Bhopal, India
- Lee Jin Koh
- 2Department of Paediatric Nephrology, Starship Children's Hospital, Auckland, New Zealand
- Chebl Mourani
- 3Pediatrics, Hôtel-Dieu de France Hospital (HDF), Beirut, Lebanon
- Marcelo de Sousa Tavares
- 4Pediatric Nephrology Unit, Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
- Khalid Alhasan
- 5Pediatric Nephrology, King Saud University College of Medicine, Riyadh, Saudi Arabia
- Michael Forbes
- 6Department of Pediatric Critical Care, Akron Children's Hospital, Akron, OH, United States
- Maninder Dhaliwal
- 7Department of Pediatric Critical Care, Institute of Liver Transplantation and Regenerative Medicine, Medanta, The Medicity, Gurgaon, India
- Veena Raghunathan
- 7Department of Pediatric Critical Care, Institute of Liver Transplantation and Regenerative Medicine, Medanta, The Medicity, Gurgaon, India
- Dieter Broering
- 8Klinik für Allgemeine und Thoraxchirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Azmeri Sultana
- 9Department of Pediatric Nephrology, Dr. M R Khan Shishu Hospital & Institute of Child Health, Dhaka, Bangladesh
- Giovanni Montini
- 0Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Giovanni Montini
- 1Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Patrick Brophy
- 2Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, United States
- Mignon McCulloch
- 3Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
- Timothy Bunchman
- 4Pediatric Nephrology and Transplantation, Children's Hospital of Richmond, Virginia Commonwealth University (VCU), Richmond, VA, United States
- Hui Kim Yap
- 0Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
- Hui Kim Yap
- 5Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Rezan Topalglu
- 6Department of Pediatric Nephrology, School of Medicine, Hacettepe University, Ankara, Turkey
- Maria Díaz-González de Ferris
- 7Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, United States
- DOI
- https://doi.org/10.3389/fped.2021.833205
- Journal volume & issue
-
Vol. 9
Abstract
Management of acute liver failure (ALF) and acute on chronic liver failure (ACLF) in the pediatric population can be challenging. Kidney manifestations of liver failure, such as hepatorenal syndrome (HRS) and acute kidney injury (AKI), are increasingly prevalent and may portend a poor prognosis. The overall incidence of AKI in children with ALF has not been well-established, partially due to the difficulty of precisely estimating kidney function in these patients. The true incidence of AKI in pediatric patients may still be underestimated due to decreased creatinine production in patients with advanced liver dysfunction and those with critical conditions including shock and cardiovascular compromise with poor kidney perfusion. Current treatment for kidney dysfunction secondary to liver failure include conservative management, intravenous fluids, and kidney replacement therapy (KRT). Despite the paucity of evidence-based recommendations concerning the application of KRT in children with kidney dysfunction in the setting of ALF, expert clinical opinions have been evaluated regarding the optimal modalities and timing of KRT, dialysis/replacement solutions, blood and dialysate flow rates and dialysis dose, and anticoagulation methods.
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