{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T22:37:02Z","timestamp":1780526222122,"version":"3.54.1"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2023,5,26]],"date-time":"2023-05-26T00:00:00Z","timestamp":1685059200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,5,26]],"date-time":"2023-05-26T00:00:00Z","timestamp":1685059200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Continuous Renal Replacement Therapy (CRRT)\u00a0machines are used off-label in patients less than 20\u00a0kg. Infant and neonates-dedicated CRRT machines are making their way into current practice, but these machines are available only in select centres. This study assesses the safety and efficacy of CRRT\u00a0using adult CRRT machines in children\u2009\u2264\u200910\u00a0kg and to\u00a0determines the factors affecting the circuit life in these children. Design: Retrospective cohort study of children\u2009\u2264\u200910\u00a0kg who received CRRT (January 2010-January 2018) at a PICU in a tertiary care centre in London, UK. Primary diagnosis, markers for illness severity, CRRT characteristics, length of PICU admission and survival to PICU discharge were collected. Descriptive analysis compared survivors and non-survivors. A subgroup analysis compared children\u2009\u2264\u20095\u00a0kg to children 5\u201310\u00a0kg. Fifty-one patients\u2009\u2264\u200910\u00a0kg received 10,328\u00a0h of CRRT, with\u00a0median weight of 5\u00a0kg. 52.94% survived to hospital discharge. Median circuit life was 44\u00a0h (IQR 24\u201368). Bleeding episodes occurred with 6.7% of sessions and hypotension for 11.9%. Analysis of efficacy showed a reduction in fluid overload at 48\u00a0h (<jats:italic>P<\/jats:italic>\u2009=\u20090.0002) and serum creatinine at 24 and 48\u00a0h (<jats:italic>P<\/jats:italic>\u2009=\u20090.001). Blood priming was deemed to be safe as serum potassium decreased at 4\u00a0h (<jats:italic>P<\/jats:italic>\u2009=\u20090.005); there was no significant change in serum calcium. Survivors had a lower PIM2 score at PICU admission (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and had longer PICU length of stay (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). <\/jats:p><jats:p>\u00a0 \u00a0<jats:italic>Conclusion<\/jats:italic>: Pending neonatal and infant dedicated CRRT machines,\u00a0CRRT can be safely and effectively applied to children weighing\u2009\u2264\u200910\u00a0kg using adult-sized CRRT machines.<jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is Known:<\/jats:bold><jats:italic>\u2022 Continuous Renal Replacement Therapy can be used for a variety of renal and non-renal indications to improve outcomes for children in the paediatric intensive care unit. These include, persistent oliguria, fluid overload, hyperkalaemia, metabolic acidosis, hyperlactatemia, hyperammonaemia, and hepatic encephalopathy.<\/jats:italic><jats:italic>\u2022 Young children\u2009\u2264\u200910\u00a0kg are most often treated using standard adult machines, off-label. This potentially places them at risk of side effects due to high extracorporeal circuit volumes, relatively higher blood flows, and difficulty in achieving vascular access.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is New:<\/jats:bold><jats:italic>\u2022 This study found that standard adult machines were effective in reducing fluid overload and creatinine in children\u2009\u2264\u200910\u00a0kg. This study also assessed safety of blood priming in this group and found no evidence of an acute fall in haemoglobin or calcium, and a fall in serum potassium by a median of 0.3\u00a0mmol\/L. The frequency of bleeding episodes was 6.7%, and hypotension requiring vasopressors or fluid resuscitation occurred with 11.9% of treatment sessions.<\/jats:italic><jats:italic>\u2022 These findings suggest that adult CRRT machines are sufficiently safe and efficacious for routine use in PICU for children\u2009\u2264\u200910\u00a0kg and suggest that further research is undertaken, regarding the routine rollout of dedicated machines.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s00431-023-05007-y","type":"journal-article","created":{"date-parts":[[2023,5,26]],"date-time":"2023-05-26T04:02:29Z","timestamp":1685073749000},"page":"3619-3629","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Safety and efficacy of continuous renal replacement therapy for children less than 10\u00a0kg using standard adult machines"],"prefix":"10.1007","volume":"182","author":[{"given":"Manju","family":"Kedarnath","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma C.","family":"Alexander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akash","family":"Deep","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,5,26]]},"reference":[{"key":"5007_CR1","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1186\/s13054-022-04083-0","volume":"26","author":"Y Kuai","year":"2022","unstructured":"Kuai Y, Li M, Chen J, Jiang Z, Bai Z, Huang H, Wei L, Liu N, Li X, Lu G, Li Y (2022) Comparison of diagnostic criteria for acute kidney injury in critically ill children: a multicenter cohort study. 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All other authors declare no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}