Evaluation of patients performed continuous renal replacement therapy in OUR pediatric intensive care unit

Objective: In our study; It was aimed to analyze the continuous renal replacement therapy (CRRT) applications in our pediatric intensive care unit. In addition, it was aimed to evaluate the demographic and epidemiological aspects of patients who underwent CRRT and to determine the appropriate model and factors affecting survival. Material and Method: Our study was planned as a retrospective, prospective and cross-sectional study. In our study, the data of patients who underwent CRRT in the Pediatric Intensive Care Unit of Çukurova University Medical Faculty Balcalı Hospital between September 2014 and January 2022 were evaluated. Demographic characteristics of patients (age, gender), body weight, height, body mass index, underlying primary disease, reason for hospitalization in the pediatric intensive care unit, duration of hospitalization in the pediatric intensive care unit, PRISM-III and PELOD-II scores recorded during hospitalization, organ failure number and types, total duration of CRRT during the pediatric intensive care unit stay, length of hospital stay, and mortality in the intensive care unit were recorded. In order to evaluate the characteristics of CRRT, the indication of CRRT, the selected CRRT mode, the location of the vascular pathway used and the size of the catheter, the filter type used, the life of the filter, the solution used during priming, the anticoagulant method used, the CRRT solution, and the fluid load at the start of CRRT were evaluated. Results: The female sex ratio was 52.9%, and the mean age of the patients was 63.8±67.6 months. The mean body weight of the patients was determined as 18.9±17.8 kg. It was observed that 17.6% of the patients died during their intensive care stay. Considering the underlying primary diseases, the most common causes were nephrological (37.6%), metabolic (25.9%) and cardiovascular (12.9%) causes, respectively. Of 125 procedures applied, 88.8% were CVVHDF and 11.2% were CVVHD. Polyarylethersulfone was used in 64% of the procedures in which continuous renal replacement therapy was applied, and a filter with AN69 membrane structure was used in 36%. Complications were observed during the procedure in 68% of the patients. The most common complications were metabolic imbalance with 47.2%, coagulation in the circuit with 27.2% and hypotension with 14.4%. It was observed that hypokalemia developed in 50.9% of the patients with metabolic imbalance, hypocalcemia in 49.2% and hypophosphatemia in 16.9%. In our study, it was observed that classical heparin was used in 44.8% of CRRT procedures and citrate was used in 14.4%. It was determined that there was no significant difference in terms of complications in patients who were administered heparin and citrate (p>0.05). In terms of filter life, it was determined that the filter life of the patients treated with heparin was significantly shorter (p=0.002). It was determined that there was no relationship between the anticoagulation method used in the patients and mortality (p>0.05). It was observed that low pH and HCO3 values and high lactate level, which are laboratory parameters obtained before CRRT, increased mortality (p=0.001, p=0.047 and p=0.001, respectively). It was observed that there was no significant relationship between serum electrolyte levels obtained in the pre-treatment period and mortality (p>0.05). Conclusion: The success of CRRT treatment depends on the clinical condition of the patient, the treatable comorbidities, the control of technical problems and the experience of the teams. CRRT is a very important extracorporeal treatment method and a life-saving procedure in intensive care units. In order to support the findings obtained in our study, multicentred randomized controlled studies are required. Key Words: Continuous Renal Replacement Therapy, Intensive Care Unit, Pediatrics