Dialysis disequilibrium on CKRT: avoiding the steep slippery slope.
Pediatr Nephrol
; 36(9): 2697-2702, 2021 09.
Article
em En
| MEDLINE
| ID: mdl-33835264
ABSTRACT
BACKGROUND:
Current guidelines for initiation of kidney replacement do not include specific recommendations for prescription parameters and monitoring. CASE OUTLINE A 16-year-old girl presented with kidney failure with creatinine of 19.8 mg/dL and BUN of 211 mg/dL. She initiated continuous kidney replacement therapy (CKRT) with clearance of 1,300 mL/min/1.73 m2 which was increased to 1,950 mL/min/1.73 m2 at 17 h of stable therapy. COMPLICATIONS At 31 h of therapy, she developed generalized seizure activity. CT imaging was negative for acute intracranial process, and EEG demonstrated diffuse encephalopathy. CKRT was discontinued, and BUN was noted to be 47 mg/dL at that time (a 79% reduction from presenting BUN). KEY MANAGEMENT POINTS ⢠The potential for development of DDS is not isolated to intermittent hemodialysis and may occur later in presentation. ⢠A decreased clearance rate should be considered in those with risk factors for development of dialysis disequilibrium syndrome (DDS). ⢠Frequent monitoring of BUN/serum osmolality is important to allow for adjustment of the KRT prescription following initiation of therapy. ⢠Additional research is needed to guide risk assessment for DDS and therapeutic timing and goals in the early stages of KRT initiation. ⢠Inclusion of more specific guidelines surrounding DDS would assist in providing important support for nephrologists. LIST OF RELEVANT GUIDELINES KDIGO clinical practice guideline for acute kidney injury [1] Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease [2] The Renal Association Clinical Practice Guideline Acute Kidney Injury (AKI) [3] The Japanese Clinical Practice Guideline for Acute Kidney Injury [4].Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Insuficiência Renal
/
Terapia de Substituição Renal Contínua
Tipo de estudo:
Guideline
/
Risk_factors_studies
Limite:
Adolescent
/
Female
/
Humans
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article