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Minerva Pediatrica 2016 October;68(5):366-73


lingua: Inglese

Dialytic dose in pediatric continuous renal replacement therapy patients

Zaccaria RICCI 1, Francesco GUZZI 2, Germana TUCCINARDI 3, 4, Stefano ROMAGNOLI 4, 5

1 Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy; 2 Nephrology and Dialysis Unit, Meyer Children’s Hospital, Florence, Italy; 3 Department of Pediatric Neuroanesthesia/NeuroICU and Pediatric Trauma Center, Meyer Children’s Hospital, Florence, Italy; 4 Section of Anesthesiology and Intensive Care, Department of Health Science, University of Florence, Florence, Italy; 5 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy


Although universally recognized as a crucial component of renal replacement therapy (RRT), dialytic dose has not been investigated in children with renal failure, differently from the adult population. Consequently, clear indications on the adequacy of continuous RRT in pediatric population is currently missing and wide variations in clinical practice exist worldwide. Fluid balance has been identified as a key factor in affecting outcomes these patients. Nonetheless, the concept and the precise evaluation of the dialytic dose for continuous pediatric RRT seems crucial, especially in light of the small body surface area of neonates and infants that might result into a difficult dose calculation. The present review clearly demonstrates that dialytic dose in pediatric RRT has been underestimated by scientific literature. Nowadays, the absence of any specific dedicated prospective study and the tendency to overlook theoretical basis of pediatric dialytic dose have led to the absence of a standard prescription: worldwide clinical practice ranges from very high doses to lower ones, also depending on different ways of estimating patients’ sizes and solutes’ volume of distribution. Large structured studies are warranted in order to define a reference dialytic dose for critically ill children, capable to cope an adequate solute control to gentle and safe treatments.

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