Abstract O-48: USE OF CONTINUOUS RENAL REPLACEMENT THERAPY BY PAEDIATRIC INTENSIVE CARE UNITS IN THE UK AND THE REPUBLIC OF IRELAND
Aims & Objectives:
To better understand how extracorporeal methods of continuous renal replacement therapy (CRRT) are being employed across the UK and Republic of Ireland given the paucity of high level evidence and the need for future randomised controlled trials.
Data on a subset of children receiving CRRT and collected as a voluntary additional audit dataset were abstracted from the UK and Republic of Ireland Paediatric Intensive Care Audit Network (PICANet). All admissions collected by volunteer PICUs between April 2015 and October 2017 were reviewed.
478 admissions (447 children) received CRRT in 19 units; range 1–94 CRRT admissions per unit. The commonest mode of CRRT employed was haemofiltration (CVVH) (75%), followed by haemodialfiltration (CVVHDF) (16%). A combination of modalities was employed in 7% of cases. In 5/19 units CVVHDF was the preferred first line modality. ‘Dose’ of CRRT (ultrafiltration and/or dialysate rates) varied widely within and between units. CRRT was initiated early, median=18.3 (IQR=5.8–66) hours following PIC admission. Overall mortality in this cohort was 32% (152 admissions); higher in neonates (42/90 (46.7%)), than infants (30/78 (38.5%)) or older children (80/310(25.8%)). 57/310 (18.4%) of the older child cohort required ongoing RRT at the time of PICU discharge (neonates 5/90 (5.6%), infant 10/78 (12.8%)).
Addition of a renal dataset to the core PICANet dataset has provided valuable contemporary information on CRRT use. Significant variation in choice of modality and dose is evident. Mortality remains high in patients who receive CRRT, and a significant proportion are left with renal morbidity.Copyright © 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies