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Kidney Week

Abstract: FR-PO712

Perceptions and Practice Surrounding Pediatric CRRT Liberation

Session Information

  • Pediatric Nephrology - 1
    October 25, 2024 | Location: Exhibit Hall, Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Rajadhyaksha, Evan Ajit, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, United States
  • Fuhrman, Dana Y., UPMC, Pittsburgh, Pennsylvania, United States
  • Selewski, David T., Medical University of South Carolina, Charleston, South Carolina, United States
  • Menon, Shina, Seattle Children's Hospital, Seattle, Washington, United States
  • Gist, Katja M., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Starr, Michelle C., Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, United States
Background

Recent work by WE-ROCK reports a lower likelihood of Continuous Renal Replacement Therapy (CRRT) liberation with longer duration of therapy or low urine output. However, approaches to CRRT liberation and factors influencing decision-making remain inadequately studied.

Methods

A survey was distributed internationally through WE-ROCK to characterize perceptions and practice surrounding CRRT liberation in pediatric patients.

Results

Of 206 respondents, 37% were nephrologists and 63% were intensivists. Fourteen countries were represented (85% USA). Few (4%) reported an institutional standardized approach to CRRT liberation, though 28% had a personal approach. Reported approaches most often (59%) included loop and thiazide diuretics, given at median 4h after stopping CRRT (IQR 2-6h).

Cumulative fluid balance and expected fluid intake were rated the most important factors in determining readiness to attempt liberation (Figure 1A), followed by urine output in response to diuretics. Cumulative fluid balance and urine output in response to diuretics were considered most important in determining CRRT liberation success (Figure 1B).

Nephrologists were more likely than intensivists to rate native urine output (73% vs. 48%, p=0.01) and number of vasoactive medications (62% vs. 38%, p=0.04) as important determinants of readiness to attempt CRRT liberation, and they placed higher importance on spontaneous urine output (85% vs 65%, p=0.03) for determining successful liberation.

Conclusion

These findings provide a first look at current CRRT liberation practices in pediatrics. Variation in approach to CRRT liberation and differences in stakeholders’ perceptions of factor importance highlight the need for further research and standardization.

Factors in Determining Readiness to Liberate from CRRT

Factors in Determining CRRT Liberation Success