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Pediatric Bone Marrow Transplant (BMT) Recipients with Acute Renal Failure (ARF): Assessment of an Algorithm to Prevent Fluid Overload including Early Initiation of Renal Replacement Therapy (RRT)
Author(s) -
Michael M,
Goldstein SL.
Publication year - 2003
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1046/j.1492-7535.2003.01280.x
Subject(s) - medicine , renal replacement therapy , hemodialysis , septic shock , furosemide , sepsis , surgery
Objective: ARF with fluid overload (FO) occurs often in BMT recipients. We have demonstrated increasing %FO prior to CRRT initiation is associated with mortality in children with ARF. Based on these data, we devised a protocol for FO prevention in BMT pts with ARF. BMT pts with ARF and 5% FO were started on furosemide and low‐dose dopamine. To allow for nutrition, medication and blood product administration, RRT was initiated for pts with ≥ 10% FO. We reviewed the course and outcome for pediatric BMT pts with ARF and fluid overload managed with this protocol. Subjects: Medical records of 29 BMT pts with 33 ARF episodes from Jan 99 to Jan 02 were reviewed. Mean pt age was 12.8 ± 5 yrs (2–23.5 yrs). Outcome: 14/29 (48%) pts survived an initial ARF episode. 0/4 pts survived a second ARF episode. 14/14 survivors (S) either maintained ≤10% FO during course or re‐attained ≤10%FO with RRT treatment. Max %FO for S was 17%. 7/19 non‐survivors (NS) were <10% FO at the time of death. 4/18 (22%) pts who received RRT (3 HD, 15 CRRT) survived. 2/15 (13%) CRRT pts survived. Mechanical ventilation, Pediatric Risk of Mortality score ≥10 at ICU admission and use of >1 pressors were associated with lower survival (p < 0.05). Neither GVHD nor septic shock correlated with survival. Conclusion: Our data demonstrate that maintenance of euvolemia (%FO ≤10% is critical for S in BMT patients with ARF as all non‐euvolemic pts died. We suggest that aggressive management with diuretics and earlier RRT initiation in pts not responsive to diuretics may improve BMT pt survival.