Kidney replacement therapy in pediatric patients on mechanical circulatory support: challenges for the pediatric nephrologist

The use of mechanical circulatory support (MCS) therapies in children with medically refractory cardiac failure has increased over the past two decades. With the growing experience and expertise, MCS is currently offered as a bridge to recovery or heart transplantation and in some cases even as dest...

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Bibliographic Details
Published in:Pediatric nephrology (Berlin, West) West), 2021-05, Vol.36 (5), p.1109-1117
Main Authors: Idrovo, Alexandra, Afonso, Natasha, Price, Jack, Tume, Sebastian, Akcan-Arikan, Ayse
Format: Article
Language:English
Subjects:
Acute Kidney Injury - therapy
Acute renal failure
Blood
Care and treatment
Child
Children
Circulation, Artificial
Complications and side effects
Congestive heart failure
Educational Review
Heart failure
Heart Failure - therapy
Heart Transplantation
Heart-Assist Devices
Humans
Kidneys
Medicine
Medicine & Public Health
Nephrology
Pediatric research
Pediatrics
Renal Replacement Therapy
Surgery
Transplantation
Urology
Ventricle
What’s new in AKI
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Summary:The use of mechanical circulatory support (MCS) therapies in children with medically refractory cardiac failure has increased over the past two decades. With the growing experience and expertise, MCS is currently offered as a bridge to recovery or heart transplantation and in some cases even as destination therapy. Acute kidney injury (AKI) is common in patients with end-stage heart failure (ESHF). When severe AKI develops requiring kidney replacement therapy (KRT), these patients present unique challenges for the pediatric nephrology team. The use of KRT has not been adequately described in children with ESHF on the newer MCS. We also present original case series data from our center experience. The purpose of this review is to familiarize the reader with the current MCS technologies, approach to their selection, how they interact when combined with current KRT circuits, and distinguish similarities and differences. We will attempt to highlight the distinctive features of each technology, specifically focusing on growing trends in use of continuous-flow ventricular assist devices (CF-VAD) as it poses additional challenges to the pediatric nephrologist.
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-020-04605-4