Keyword: Veno-Venous Hemodiafiltration
1 result found.
Congress Abstract
Central Asian Journal of Nephrology, 2(2, Suppl. 1), 2026, cajn_A36, https://doi.org/10.63946/cajn/19518
ABSTRACT:
Background: Acute kidney injury (AKI) is a major contributor to morbidity and mortality in critically ill children, and rhabdomyolysis is an important yet underrecognized trigger of severe AKI after major trauma. Continuous veno-venous hemodiafiltration (CVVHDF) allows simultaneous correction of fluid, electrolyte and acid–base disturbances together with clearance of myoglobin and inflammatory mediators in hemodynamically unstable patients. Data on adequately dosed, prolonged CVVHDF in adolescents with combined trauma-induced rhabdomyolysis and septic acute kidney injury remain limited. We report a case of severe RIFLE-Failure AKI in a polytrauma adolescent successfully managed with 15 days of continuous renal replacement therapy.
Case Presentation: A 13-year-old boy (weight 85–90 kg) was admitted to the pediatric intensive care unit after severe polytrauma sustained in a road traffic accident and underwent intramedullary osteosynthesis of long-bone fractures. On postoperative day 3 he developed a hardware-associated abscess with systemic inflammatory response and sepsis, complicated by traumatic rhabdomyolysis and severe AKI, RIFLE-Failure stage: anuria, metabolic acidosis, hyperkalemia and rising azotemia. Baseline values were creatinine 567 µmol/L, potassium 6.16 mmol/L, pH 7.28, AST 7001 U/L and ALT 5591 U/L.
CVVHDF was initiated on postoperative day 3 via an internal jugular venous catheter, using a MultiFiltrate® platform (Fresenius Medical Care): blood flow 200 mL/min, dialysate and replacement fluid each 1500 mL/h, ultrafiltration 100 mL/h, corresponding to an effluent dose of approximately 34–36 mL/kg/h. Anticoagulation was maintained with unfractionated heparin 1250 U/h under laboratory monitoring. Therapy continued for 15 days without catheter- or circuit-related complications. Progressive correction of acidosis, hyperkalemia, azotemia and cytolysis markers was achieved (Table 1), and diuresis recovered to 1150 mL/day by day 15, allowing discontinuation of extracorporeal support; the patient was transferred from the intensive care unit to a specialized ward.
Conclusion: This case demonstrates that adequately dosed, prolonged CVVHDF (≈35 mL/kg/h) can safely and effectively reverse life-threatening metabolic derangements and achieve complete renal recovery in an adolescent with trauma-induced rhabdomyolysis and septic RIFLE-Failure acute kidney injury. Early initiation on postoperative day 3, uncomplicated vascular access and close monitoring supported an uneventful 15-day course. The case underscores the role of timely, adequately dosed continuous renal replacement therapy as a bridge to renal recovery in pediatric trauma patients with combined rhabdomyolysis and sepsis-associated acute kidney injury.
Case Presentation: A 13-year-old boy (weight 85–90 kg) was admitted to the pediatric intensive care unit after severe polytrauma sustained in a road traffic accident and underwent intramedullary osteosynthesis of long-bone fractures. On postoperative day 3 he developed a hardware-associated abscess with systemic inflammatory response and sepsis, complicated by traumatic rhabdomyolysis and severe AKI, RIFLE-Failure stage: anuria, metabolic acidosis, hyperkalemia and rising azotemia. Baseline values were creatinine 567 µmol/L, potassium 6.16 mmol/L, pH 7.28, AST 7001 U/L and ALT 5591 U/L.
CVVHDF was initiated on postoperative day 3 via an internal jugular venous catheter, using a MultiFiltrate® platform (Fresenius Medical Care): blood flow 200 mL/min, dialysate and replacement fluid each 1500 mL/h, ultrafiltration 100 mL/h, corresponding to an effluent dose of approximately 34–36 mL/kg/h. Anticoagulation was maintained with unfractionated heparin 1250 U/h under laboratory monitoring. Therapy continued for 15 days without catheter- or circuit-related complications. Progressive correction of acidosis, hyperkalemia, azotemia and cytolysis markers was achieved (Table 1), and diuresis recovered to 1150 mL/day by day 15, allowing discontinuation of extracorporeal support; the patient was transferred from the intensive care unit to a specialized ward.
Conclusion: This case demonstrates that adequately dosed, prolonged CVVHDF (≈35 mL/kg/h) can safely and effectively reverse life-threatening metabolic derangements and achieve complete renal recovery in an adolescent with trauma-induced rhabdomyolysis and septic RIFLE-Failure acute kidney injury. Early initiation on postoperative day 3, uncomplicated vascular access and close monitoring supported an uneventful 15-day course. The case underscores the role of timely, adequately dosed continuous renal replacement therapy as a bridge to renal recovery in pediatric trauma patients with combined rhabdomyolysis and sepsis-associated acute kidney injury.
