New Review Article Discusses Best Practices for Use of Continuous Kidney Replacement Therapy in Conjunction with ECMO in Pediatric Patients

In February 2024, contributors to the Pediatric Continuous Renal Replacement Therapy (PCRRT) Workgroup and the International Collaboration of Nephrologists and Intensivists for Critical Care Children (ICONIC) published a new review article in Pediatric Nephrology on the use of continuous kidney replacement therapy (CKRT) in critically ill pediatric patients on extracorporeal membrane oxygenation (ECMO).

Contributing to the review article from the UPMC Children’s Hospital of Pittsburgh Division of Pediatric Nephrology were fellow Tara Beck, DO, and Dana Y. Fuhrman, DO, MS. Dr. Beck is a PGY-5 fellow and Dr. Fuhrman is an associate professor of Pediatrics, as well as the program director of the Pediatric Critical Care Medicine Fellowship, and director of the Continuous Renal Replacement Therapy Program in the Division.

About the Review: Important Considerations for Clinical Practice

CKRT is often necessary for pediatric patients on ECMO due to several critical needs. CKRT helps manage fluid overload, which is can be a common complication. CKRT also supports kidney function when injury or malfunction is present. Additionally, CKRT is crucial for maintaining electrolyte balance and can help clear inflammatory mediators, reducing potential inflammation-related complications.

The new review article focuses on current best practices and guidelines on the use of CKRT in conjunction with ECMO in critically ill pediatric patients, and the known risks and potential renal complications that can occur in patients on ECMO support.

Discussed in the review are the typical indications and parameters under which CKRT should be used in conjunction with ECMO – most notable acute kidney injury, fluid overload, and electrolyte disturbances, and various methods by which CKRT can be integrated into the ECMO circuit, the modality of which generally depends on the patient's condition and the expertise of the health care team.

The article also highlights the critical role anticoagulation strategies play in ECMO and covers the most used therapeutics along with potential complications or contraindications. The use of therapeutic plasma exchange also is explained.

Additionally, the review explores some of what is currently know about patient outcomes when CKRT is used alongside ECMO, with specific sections on fluid overload management, ECMO-associated AKI, and overall mortality rates.

Read more or download a copy of the review using the reference link below.

Reference

Raina R, Nair N, Pelletier J, et al. Concurrent Use of Continuous Kidney Replacement Therapy During Extracorporeal Membrane Oxygenation: What Pediatric Nephrologists Need to Know – PCRRT-ICONIC Practice Points. Pediatr Nephrol. 2024 Feb 2022. Online ahead of print.