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Journal of the Korean Society of Pediatric Nephrology 2007;11(2): 247-254. doi: https://doi.org/10.3339/jkspn.2007.11.2.247
소아 중환자에서 지속적 신대체요법의 치료 결과와 예후
박광식, 손기영, 황유식, 김정아, 정일천, 신재일, 박지민, 안선영, 유철주, 이재승
1연세대학교 의과대학 세브란스 어린이병원 소아과, 신장질환 연구소
2연세대학교 의과대학 세브란스 어린이병원 소아과, 신장질환 연구소
3연세대학교 의과대학 세브란스 어린이병원 소아과, 신장질환 연구소
4연세대학교 의과대학 세브란스 어린이병원 소아과, 신장질환 연구소
5연세대학교 의과대학 세브란스 어린이병원 소아과, 신장질환 연구소
6연세대학교 의과대학 세브란스 어린이병원 소아과, 신장질환 연구소
7연세대학교 의과대학 세브란스 어린이병원 소아과, 신장질환 연구소
8연세대학교 의과대학 세브란스 어린이병원 소아과, 신장질환 연구소
9연세대학교 의과대학 세브란스 어린이병원 소아과, 신장질환 연구소
10연세대학교 의과대학 세브란스 어린이병원 소아과, 신장질환 연구소
Outcome and Prognosis in Critically III Children Receiving Continuous Renal Replacement Therapy
Kwang-Sik Park, Ki-Young Son, You-Sik Hwang, Joung-A Kim, Il-Chun Cheung, Jae-Il Shin, Ji-Min Park, Sun-Young Ahn, Chuhl-Joo Lyu, Jae-Seung Lee
1Department of Pediatrics, Severance Childrens Hospital, The Institute of Kidney Disease Yonsei University College of Medicine
2Department of Pediatrics, Severance Childrens Hospital, The Institute of Kidney Disease Yonsei University College of Medicine
3Department of Pediatrics, Severance Childrens Hospital, The Institute of Kidney Disease Yonsei University College of Medicine
4Department of Pediatrics, Severance Childrens Hospital, The Institute of Kidney Disease Yonsei University College of Medicine
5Department of Pediatrics, Severance Childrens Hospital, The Institute of Kidney Disease Yonsei University College of Medicine
6Department of Pediatrics, Severance Childrens Hospital, The Institute of Kidney Disease Yonsei University College of Medicine
7Department of Pediatrics, Severance Childrens Hospital, The Institute of Kidney Disease Yonsei University College of Medicine
8Department of Pediatrics, Severance Childrens Hospital, The Institute of Kidney Disease Yonsei University College of Medicine
9Department of Pediatrics, Severance Childrens Hospital, The Institute of Kidney Disease Yonsei University College of Medicine
10Department of Pediatrics, Severance Childrens Hospital, The Institute of Kidney Disease Yonsei University College of Medicine
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ABSTRACT
Purpose : Continuous renal replacement therapy(CRRT) has been the first choice for the treatment of acute renal failure in critically ill children not only in western countries but also in Korea. However, there are very few studies that have analyzed the outcome and prognosis of this modality in Korean children. We performed this study to evaluate the factors associated with the outcome and prognosis of patients treated with CRRT.
Methods : We retrospectively reviewed the medical records of 32 children who had received CRRT at Severance hospital from 2003 to 2006. The mean age was 7.5 years(range 4 days-16 years) and the mean body weight was 25.8 kg (range 3.2-63 kg).
Results : Eleven(34.4%) of the 32 patients survived. Bone marrow transplantation and malignancy were the most common causes of death and underlying disease leading to the need for CRRT Mean patient weight, age, duration of CRRT, number of organ failures, urine output, estimated glomerular filtration rate(eGFR), C-reactive protein, and blood urea level did not differ significantly between survivors and nonsurvivors. (1) Pediatric risk of mortality(PRISM) III score at CRRT initiation($9.8{pm}5.3$ vs. $26.7{pm}7.6$, P<0.0001), (2) maximum pressor number ($2.1{pm}1.2$ vs. $3.0{pm}1.0$, P=0.038), and (3) the degree of fluid overload($5.2{pm}6.0$ vs. $15.0{pm}8.9$, P=0.002) were significantly lower in survivers than in nonsurvivors. Multivariate analysis revealed that fluid overload was the only independent factor reducing survival rate.
Conclusion : CRRT was successfully applied to the treatment of acute renal failure in a wide range of critically ill children. To improve survival, we suggest the early initiation of CRRT to prevent the systemic worsening and progression of fluid overload in critically ill children with acute renal failure.
Key words: Acute renal failure | Continuous renal replacement therapy | Fluid overload | Children
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