BACKGROUND: Nutrition plays a vital role in the outcome of critically ill children, particularly those with AKI. Currently, there are no established guidelines for children with AKI treated with continuous RRT (CRRT). A thorough understanding of the metabolic changes and nutritional challenges in AKI and CRRT is required. Our objective was to create clinical practice points for nutritional assessment and management in critically ill children with AKI receiving CRRT. METHODS: PubMed, MEDLINE, Cochrane, and Embase databases were searched for articles related to the topic. Expertise of the authors and a consensus of the workgroup were additional sources of data in the article. Available articles on nutrition therapy in pediatric patients receiving CRRT through January 2023. RESULTS: On the basis of the literature review, the current evidence base was examined by a panel of experts in pediatric nephrology and nutrition. The panel used the literature review as well as their expertise to formulate clinical practice points. The modified Delphi method was used to identify and refine clinical practice points. CONCLUSIONS: Forty-four clinical practice points are provided on nutrition assessment, determining energy needs, and nutrient intake in children with AKI and on CRRT on the basis of the existing literature and expert opinions of a multidisciplinary panel.

• MeSH
• akutní poškození ledvin * terapie   MeSH
• dítě MeSH
• konsensus MeSH
• kontinuální metody náhrady funkce ledvin * MeSH
• kritický stav terapie   MeSH
• lidé MeSH
• nutriční stav MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

IMPORTANCE: Continuous kidney replacement therapy (CKRT) is the preferred method of kidney support for children with critical illness in pediatric intensive care units (PICUs). However, there are no data on the current CKRT management practices in European PICUs. OBJECTIVE: To describe current CKRT practices across European PICUs. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey of PICUs in 20 European countries was conducted by the Critical Care Nephrology Section of the European Society of Pediatric and Neonatal Intensive Care from April 1, 2020, to May 31, 2022. Participants included intensivists and nurses working in European PICUs. The survey was developed in English and distributed using SurveyMonkey. One response from each PICU that provided CKRT was included in the analysis. Data were analyzed from June 1 to June 30, 2022. MAIN OUTCOME AND MEASURES: Demographic characteristics of European PICUs along with organizational and delivery aspects of CKRT (including prescription, liberation from CKRT, and training and education) were assessed. RESULTS: Of 283 survey responses received, 161 were included in the analysis (response rate, 76%). The attending PICU consultant (70%) and the PICU team (77%) were mainly responsible for CKRT prescription, whereas the PICU nurses were responsible for circuit setup (49%) and bedside machine running (67%). Sixty-one percent of permanent nurses received training to use CKRT, with no need for certification or recertification in 36% of PICUs. Continuous venovenous hemodiafiltration was the preferred dialytic modality (51%). Circuit priming was performed with normal saline (67%) and blood priming in children weighing less than 10 kg (56%). Median (IQR) CKRT dose was 35 (30-50) mL/kg/h in neonates and 30 (30-40) mL/kg/h in children aged 1 month to 18 years. Forty-one percent of PICUs used regional unfractionated heparin infusion, whereas 35% used citrate-based regional anticoagulation. Filters were changed for filter clotting (53%) and increased transmembrane pressure (47%). For routine circuit changes, 72 hours was the cutoff in 62% of PICUs. Some PICUs (34%) monitored fluid removal goals every 4 hours, with variation from 12 hours (17%) to 24 hours (13%). Fluid removal goals ranged from 1 to 3 mL/kg/h. Liberation from CKRT was performed with a diuretic bolus followed by an infusion (32%) or a diuretic bolus alone (19%). CONCLUSIONS AND RELEVANCE: This survey study found a wide variation in current CKRT practice, including organizational aspects, education and training, prescription, and liberation from CKRT, in European PICUs. This finding calls for concerted efforts on the part of the pediatric critical care and nephrology communities to streamline CKRT education and training, research, and guidelines to reduce variation in practice.

• MeSH
• dítě MeSH
• diuretika MeSH
• heparin MeSH
• jednotky intenzivní péče pediatrické MeSH
• kontinuální metody náhrady funkce ledvin * MeSH
• lidé MeSH
• novorozenec MeSH
• průřezové studie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

INTRODUCTION: Though cost-effectiveness analyses (CEAs) have evaluated continuous renal replacement therapy (RRTs) and intermittent RRTs in acute kidney injury (AKI) patients; it is yet to establish which RRT technique is most cost-effective. We systematically reviewed the current evidence from CEAs of CRRT versus IRRT in patients with AKI. AREAS COVERED: PubMed, EMBASE, and Cochrane databases searched for CEAs comparing two RRTs. Overall, seven CEAs, two from Brazil and one from US, Canada, Colombia, Belgium, and Argentina were included. Five CEAs used Markov model, three reported following CHEERS, none accounted indirect costs. Time horizon varied from 1-year-lifetime. Marginal QALY gain with CRRT compared to IRRT was reported across CEAs. Older CEAs found CRRT to be costlier and not cost-effective than IRRT (ICER 2019 US$: 152,671$/QALY); latest CEAs (industry-sponsored) reported CRRT to be cost-saving versus IRRT (-117,614$/QALY). Risk of mortality, dialysis dependence, and incidence of renal recovery were the key drivers of cost-effectiveness. EXPERT OPINION: CEAs of RRTs for AKI show conflicting findings with secular trends. Latest CEAs suggested CRRT to be cost-effective versus IRRT with dialysis dependence rate as major driver of cost-effectiveness. Future CEAs, preferably non-industry sponsored, may account for indirect costs to improve the generalizability of CEAs.

• MeSH
• akutní poškození ledvin * terapie   MeSH
• analýza nákladů a výnosů MeSH
• dialýza ledvin MeSH
• intermitentní metody náhrady funkce ledvin * ekonomika   MeSH
• kontinuální metody náhrady funkce ledvin * ekonomika   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• systematický přehled MeSH

• Klíčová slova
• Membrána oXiris, Olimel N12,
• MeSH
• kontinuální metody náhrady funkce ledvin metody   přístrojové vybavení   MeSH
• lidé MeSH
• parenterální výživa metody   MeSH
• péče o pacienty v kritickém stavu * metody   normy   MeSH
• sepse terapie   MeSH
• tukové emulze intravenózní terapeutické užití   MeSH
• Check Tag
• lidé MeSH

• MeSH
• akutní selhání jater terapie   MeSH
• antikoagulancia terapeutické užití   MeSH
• kontinuální metody náhrady funkce ledvin metody   přístrojové vybavení   MeSH
• kyselina citronová terapeutické užití   MeSH
• multiorgánové selhání terapie   MeSH
• péče o pacienty v kritickém stavu MeSH
• septický šok terapie   MeSH
• Publikační typ
• novinové články MeSH
• rozhovory MeSH

OBJECTIVE: An arteriovenous graft (AVG) is indicated in hemodialysis patients with failed arteriovenous access. Early treatment of AVG infection is important because an advanced prosthetic infection leads to the removal of the prosthesis. The aim of this study was to evaluate the benefits of 18F-FDG PET/CT and 99mTc-HMPAO-WBC SPECT/CT in early detection of AVG infections. SUBJECTS AND METHODS: Fifty-one AVGs were evaluated. 18F-FDG PET/CT and 99mTc-HMPAO-WBC SPECT/CT studies were performed at intervals of 10, 20-30, and 40-50 weeks after AVG insertion. Agreement between the imaging methods and reference parameters (i.e. clinical presentation, C-reactive protein and microbiological findings on the hemodialysis cannula extracted after hemodialysis from AVG) was evaluated. RESULTS: The study results showed that focal accumulation of the radiopharmaceuticals can be considered a sign of AVG infection. At 10 weeks after AVG implantation, the focal 18F-FDG findings showed the best agreement with the reference parameters (agreement coefficients AC1 - clinical status: 0.693, CRP: 0.605, cannula microbiology: 0.518, respectively). At 20 to 30 weeks after AVG implantation, the diagnostic value of focal 99mTc-HMPAO-WBC accumulation increased (AC1 coefficients: 0.658, 0.658, 0.408) and was similar to that of focal 18F-FDG uptake (AC1s: 0.656, 0.570, 0.409). Between 40 and 50 weeks since AVG implantation, the diagnostic significance of focal 99mTc-HMPAO-WBC accumulation (AC1 coefficients: 0.771, 0.811, 0.611) slightly exceeded the diagnostic value of focal 18F-FDG accumulation (AC1 coefficients: 0.524, 0.456, 0.569). CONCLUSION: 18F-FDG PET/CT and 99mTc-HMPAO-WBC SPECT/CT can both serve as important tools contributing to early diagnosis of AVG infection.

• MeSH
• biologické markery krev   MeSH
• časná diagnóza MeSH
• dospělí MeSH
• fluorodeoxyglukosa F18 krev   MeSH
• infekce diagnóza   etiologie   MeSH
• kontinuální metody náhrady funkce ledvin škodlivé účinky   MeSH
• kontrola infekce metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• radiofarmaka krev   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Náhrada funkce ledvin (RRT, renal replacement therapy) je nepostradatelnou součástí léčby nemocných s pokročilými formami akutního poškození ledvin (AKI). Přibližně 4 % všech pacientů na jednotkách intenzivní péče vyžaduje některou z forem RRT. Navzdory rutinnímu používání RRT stále existuje řada kontroverzních otázek, na jejichž zodpovězení není dostatek vědeckých důkazů. Týkají se především načasování zahájení/ ukončení RRT, její intenzity či volby modality. Tento článek kriticky diskutuje o vybraných klinických publikacích uveřejněných v průběhu roku 2009, které přinášejí nové pokroky v oblasti náhrady funkce ledvin u kriticky nemocných.

Renal replacement therapy (RRT) remains the cornerstone of management of patients with established acute kidney injury (AKI). Approximately 4% of all critically ill patients in the intensive care units require some sort of RRT treatment. The fundamental management issues remain controversial despite the routine use of RRT, including the timing of RRT initiation/cessation, RRT intensity and the choice of RRT modality. This article is a critical review of selected clinical trials published during 2009 and bringing new advances in the realm of RRT in critically ill patients.

• Klíčová slova
• intermitentní hemodialýza, dialyzační dávka,
• MeSH
• akutní poškození ledvin komplikace   terapie   MeSH
• dialýza ledvin metody   trendy   využití   MeSH
• diuretika aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• financování organizované MeSH
• hemofiltrace metody   využití   MeSH
• hemoperfuze metody   využití   MeSH
• jednotky intenzivní péče využití   MeSH
• kontinuální metody náhrady funkce ledvin MeSH
• lidé MeSH
• medicína založená na důkazech trendy   MeSH
• metaanalýza jako téma MeSH
• náhrada funkce ledvin metody   trendy   využití   MeSH
• péče o pacienty v kritickém stavu metody   využití   MeSH
• polymyxin B terapeutické užití   MeSH
• sepse komplikace   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH