Renal replacement therapy in the management of intoxications in children: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) workgroup

Rupesh Raina; Manpreet K Grewal; Martha Blackford; Jordan M Symons; Michael J G Somers; Christoph Licht; Rajit K Basu; Sidharth Kumar Sethi; Deepa Chand; Gaurav Kapur; Mignon McCulloch; Arvind Bagga; Vinod Krishnappa; Hui-Kim Yap; Marcelo de Sousa Tavares; Timothy E Bunchman; Michelle Bestic; Bradley A Warady; Maria Díaz-González de Ferris

doi:10.1007/s00467-019-04319-2

Renal replacement therapy in the management of intoxications in children: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) workgroup

Pediatr Nephrol. 2019 Nov;34(11):2427-2448. doi: 10.1007/s00467-019-04319-2. Epub 2019 Aug 24.

Authors

Rupesh Raina^{1

2}, Manpreet K Grewal³, Martha Blackford⁴, Jordan M Symons⁵, Michael J G Somers⁶, Christoph Licht⁷, Rajit K Basu⁸, Sidharth Kumar Sethi⁹, Deepa Chand¹⁰, Gaurav Kapur¹¹, Mignon McCulloch¹², Arvind Bagga¹³, Vinod Krishnappa³, Hui-Kim Yap¹⁴, Marcelo de Sousa Tavares¹⁵, Timothy E Bunchman¹⁶, Michelle Bestic⁴, Bradley A Warady¹⁷, Maria Díaz-González de Ferris¹⁸

Affiliations

¹ Department of Nephrology, Akron Children's Hospital, Akron, OH, USA. RRaina@akronchildrens.org.
² Akron Nephrology Associates/Cleveland Clinic Akron General, 224 W. Exchange St., Akron, OH, 44302, USA. RRaina@akronchildrens.org.
³ Akron Nephrology Associates/Cleveland Clinic Akron General, 224 W. Exchange St., Akron, OH, 44302, USA.
⁴ Division of Clinical Pharmacology & Toxicology, Akron Children's Hospital, Akron, OH, USA.
⁵ Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
⁶ Division of Nephrology, Boston Children's Hospital, Boston, MA, USA.
⁷ Division of Nephrology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
⁸ Department of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
⁹ Pediatric Nephrology & Pediatric Kidney Transplantation, Kidney and Urology Institute, Medanta, The Medicity Hospital, Gurgaon, India.
¹⁰ Division of Pediatric Nephrology, Washington University School of Medicine, St. Louis, MO, USA.
¹¹ Department of Pediatric Nephrology, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.
¹² Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
¹³ Division of Paediatric Nephrology, All India Institute of Medical Sciences, New Delhi, India.
¹⁴ Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
¹⁵ Department of Paediatrics, Medical School, Universidade Nove de Julho, São Paulo, Brazil.
¹⁶ Pediatric Nephrology & Transplantation, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, USA.
¹⁷ Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA.
¹⁸ Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

PMID: 31446483
DOI: 10.1007/s00467-019-04319-2

Abstract

Background: Intentional or unintentional ingestions among children and adolescents are common. There are a number of ingestions amenable to renal replacement therapy (RRT).

Methods: We systematically searched PubMed/Medline, Embase, and Cochrane databases for literature regarding drugs/intoxicants and treatment with RRT in pediatric populations. Two experts from the PCRRT (Pediatric Continuous Renal Replacement Therapy) workgroup assessed titles, abstracts, and full-text articles for extraction of data. The data from the literature search was shared with the PCRRT workgroup and two expert toxicologists, and expert panel recommendations were developed.

Results and conclusions: We have presented the recommendations concerning the use of RRTs for treatment of intoxications with toxic alcohols, lithium, vancomycin, theophylline, barbiturates, metformin, carbamazepine, methotrexate, phenytoin, acetaminophen, salicylates, valproic acid, and aminoglycosides.

Keywords: Children; Hemodialysis; Intoxications; Renal replacement therapies.

Publication types

Systematic Review

MeSH terms

Acute Kidney Injury / diagnosis
Acute Kidney Injury / etiology
Acute Kidney Injury / therapy*
Adolescent
Child
Child, Preschool
Consensus Development Conferences as Topic
Consensus*
Female
Humans
Infant
Male
Nephrology / standards
Poisoning / diagnosis
Poisoning / etiology
Poisoning / therapy*
Practice Guidelines as Topic*
Renal Replacement Therapy / standards*
Young Adult