ASHLEA ANDERSON, APRN
APRN
St Jude Children's Research Hospital, United States
Disclosure information not submitted.
LAURIE SHOULDERS, MSN-RN
MSN-RN
St Jude Children's Research Hospital, United States
Disclosure information not submitted.
Lama Elbahlawan, MD
St Jude Children's Research Hospital
Germantown, Tennessee
Disclosure information not submitted.
Title: Outcome of Continuous Renal Replacement Therapy in Critically Ill Children with Tumor Lysis Syndrome
INTRODUCTION, Tumor lysis syndrome (TLS) is common in children with hematological malignancies and can be life threatening due to metabolic disturbances. Continuous renal replacement therapy (CRRT) can reverse these disturbances relatively fast when conventional medical management fails. Our study aimed to evaluate the benefit and outcome of CRRT in critically ill children with TLS.
METHODS, Retrospective review of all children admitted to the intensive care unit (ICU) with TLS who received CRRT from 2009-2019.
RESULTS, Among 199 children admitted with TLS from 2009-2019, 13 underwent CRRT for TLS in ICU (incidence rate of 65 per 1000). Oncologic diagnosis was ALL in 54%, AML in 23%, and Burkitt lymphoma in 23%. Mean age was 14 years and majority were males (92%). One third of our cohort was intubated and 15% were on vasopressors. All patients received aggressive fluid hydration, Rasburicase, and phosphate binders before CRRT. Two patients received one run of intermittent hemodialysis (IHD) prior to CRRT. Continuous veno-venous hemodiafiltration was the modality of CRRT in most of the cohort (92%). Most common indications for CRRT were hyperphosphatemia (84%) with concomitant hypocalcemia (only 2 patients didn’t have hyperphosphatemia but received a session of IHD just prior to CRRT), hyperkalemia (46%), and hyperuricemia (23%). All metabolic abnormalities corrected within 24 hours of commence of CRRT. CRRT courses were brief with mean duration of 2.2 days. One patient who had prior stem cell transplant died with refractory relapsed B-cell ALL and multiorgan dysfunction. One patient required IHD for 2 weeks after end of CRRT.
CONCLUSION, CRRT is safe and effective for management of TLS when other medical approach fails. CRRT may render a better renal replacement therapy compared to IHD in these situations as it reduces the rebound of these metabolic abnormalities by sustained slow removal rate.