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PCRRT Expert Committee ICONIC Position Paper on Prescribing Kidney Replacement Therapy in Critically Sick Children With Acute Liver Failure
Frontiers in Pediatrics
  • Rupesh Raina, Akron General Medical Center
  • Sidharth K. Sethi, Medicity Hospital
  • Guido Filler, Western University
  • Shina Menon, University of Washington School of Medicine
  • Aliza Mittal, All India Institute of Medical Sciences, Jodhpur
  • Amrit Khooblall, Akron General Medical Center
  • Prajit Khooblall, Akron Nephrology Associates
  • Ronith Chakraborty, Akron General Medical Center
  • Harsha Adnani, Anne Arundel Medical Center
  • Nina Vijayvargiya, Akron General Medical Center
  • Sharon Teo, National University Hospital
  • Girish Bhatt, All India Institute of Medical Sciences Bhopal
  • Lee Jin Koh, Starship Children's Health
  • Chebl Mourani, Hôtel-Dieu de France Hospital
  • Marcelo de Sousa Tavares, Santa Casa de Belo Horizonte
  • Khalid Alhasan, King Saud University
  • Michael Forbes, Akron Children's Hospital
  • Maninder Dhaliwal, The Medicity
  • Veena Raghunathan, The Medicity
  • Dieter Broering, Universitätsklinikum Schleswig-Holstein Campus Kiel
  • Azmeri Sultana, Dhaka Shishu Hospital
  • Giovanni Montini, Ospedale Maggiore Policlinico Milano
  • Patrick Brophy, University of Rochester School of Medicine and Dentistry
  • Mignon McCulloch, University of Cape Town
  • Timothy Bunchman, Virginia Commonwealth University
  • Hui Kim Yap, National University Hospital
  • Rezan Topalglu, Hacettepe Üniversitesi
  • Maria Díaz-González de Ferris, UNC School of Medicine
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Management of acute liver failure (ALF) and acute on chronic liver failure (ACLF) in the pediatric population can be challenging. Kidney manifestations of liver failure, such as hepatorenal syndrome (HRS) and acute kidney injury (AKI), are increasingly prevalent and may portend a poor prognosis. The overall incidence of AKI in children with ALF has not been well-established, partially due to the difficulty of precisely estimating kidney function in these patients. The true incidence of AKI in pediatric patients may still be underestimated due to decreased creatinine production in patients with advanced liver dysfunction and those with critical conditions including shock and cardiovascular compromise with poor kidney perfusion. Current treatment for kidney dysfunction secondary to liver failure include conservative management, intravenous fluids, and kidney replacement therapy (KRT). Despite the paucity of evidence-based recommendations concerning the application of KRT in children with kidney dysfunction in the setting of ALF, expert clinical opinions have been evaluated regarding the optimal modalities and timing of KRT, dialysis/replacement solutions, blood and dialysate flow rates and dialysis dose, and anticoagulation methods.

Citation Information
Rupesh Raina, Sidharth K. Sethi, Guido Filler, Shina Menon, et al.. "PCRRT Expert Committee ICONIC Position Paper on Prescribing Kidney Replacement Therapy in Critically Sick Children With Acute Liver Failure" Frontiers in Pediatrics Vol. 9 (2022)
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