MANAGEMENT OF ACUTE-RENAL-FAILURE IN THE PEDIATRIC-PATIENT - HEMOFILTRATION VERSUS HEMODIALYSIS

Although outcome data for acute renal failure (ARF) in the adult popul ation (analyzed by etiology of ARF, severity of illness, and modality of treatment) are readily available, few similar data exist for the pe diatric population, Pediatric survival rate data vary widely, based up on era of analysis, age and size of child, and cause of ARF. Few compa rative data are available that address impact by modality chosen to tr eat ARF. Comparison of 122 children who were treated by hemodialysis ( HD; n = 58) versus hemofiltration (HF; n = 64) reveals a combined surv ival rate of 65%, Survival by modality was higher for HD (83%) than fo r HF (48%), The major diagnosis treated with HF was sepsis (29/64; 45% ), with a survival rate of 31%, whereas the major diagnosis treated wi th HD (27/58; 46%) was primary renal failure, with a survival rate of 96%. Seventy-one percent of children undergoing HF required presser su pport for hypotension, whereas only 24% of those receiving HD needed p resser support (P < 0.01), We conclude that the choice of renal replac ement therapy (RRT) modality needs to be determined by the best treatm ent available, To adequately evaluate therapy measures, further analys es of outcome need to consider those factors that determine choice of RRT and those that affect survival independent of ARF. (C) 1997 by the National Kidney Foundation, Inc.