New Review Article Published on AKI, Fluid Overload, and the Use of CRRT in Pediatric/Neonatal ECMO Patients
September 25, 2024
UPMC Children’s Hospital of Pittsburgh Division of Pediatric Nephrology fellow Tara Beck, DO, and Dana Y. Fuhrman, DO, MS, associate professor of Pediatrics and Critical Care Medicine, were co-authors of a new multicenter review article published in Intensive Care Medicine – Paediatric and Neonatal on “Acute Kidney Injury, Fluid Imbalance, and Continuous Renal Replacement Therapy in Children and Neonates Treated with Extracorporeal Membrane Oxygenation.”
The review presents a comprehensive and up-to-date analysis of the prevalence and morbidities associated with AKI and fluid imbalance in pediatric and neonatal patients requiring ECMO support and the practices and methods of employing continuous renal replacement therapy (CRRT) in the setting of ECMO when kidney function is impaired by AKI or fluid overload is present.
Both AKI and fluid overload are well-known and prevalent concerns in ECMO patients, and their manifestation often leads to worse outcomes and other negative downstream effects. As the review points out, AKI occurs in anywhere between 60 to 80% of ECMO patients. However, there remains a lot of variability around how best to treat and manage AKI and fluid imbalances in this patient population and the best practices associated with CRRT.
“With percentages this high, every clinician and team working with ECMO patients needs to have the most current data and be informed of what are today’s best practices for dealing with AKI and fluid overload,” says Dr. Beck.
The new review provides clinicians with an in-depth analysis of AKI and FO epidemiology, how the conditions are currently being managed in patients on ECMO, preventive strategies, and considerations for the use of CRRT.
"We also discuss in the paper which areas of this clinical challenge we need to invest more work in research and where we need to have more standardized protocols of care, for example, in understanding the optimal timing in which CRRT should be initiated," says Dr. Fuhrman.
Pediatric nephrologists, intensive care providers, ECMO teams, and other disciplines are encouraged to read the new review article. A link to the open-access paper is below.
Reference
Gist KM, Bastero P, Ricci Z, et al. Acute Kidney Injury, Fluid Imbalance, and Continuous Renal Replacement Therapy in Children and Neonates Treated with Extracorporeal Membrane Oxygenation. Intensive Care Med – Paediatr Neonatal. 2024; 2: 28.
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