肿瘤溶解综合征(TLS)通常在患有血液系统恶性肿瘤的儿童中被诊断出,并且由于代谢紊乱而可能危及生命。当常规医学管理失败时,连续肾脏替代疗法(CKRT)可以相对较快地逆转这些障碍。我们的目的是调查CKRT在接受血液系统恶性肿瘤重症监护病房的儿童中的TLS管理中的益处。此外,我们试图评估TLS设置中急性肾损伤(AKI)的危险因素.
■对2012年1月至2022年8月接受CKRT的所有接受TLS重症监护病房的儿童进行回顾性审查。
■在2012年1月至2022年8月接受TLS住院的222名儿童中,有20名(9%)在重症监护病房接受了CKRT以管理TLS。患者的中位年龄为13岁(范围3-17岁),大多数是男性(18/20)。T细胞急性淋巴细胞白血病是最常见的诊断(n=10),其次是急性髓系白血病(n=4),伯基特淋巴瘤(n=4),和B细胞急性淋巴细胞白血病(n=2)。五名患者需要机械通气,和2个需要血管加压药。CKRT最常见的适应症是高磷血症,其次是,高尿酸血症,和高钾血症.所有代谢异常在CKRT开始后12小时内得到纠正。CKRT课程很简短,中位持续时间为2天(范围为1-7天)。CKRT前12小时血清磷水平较高与严重急性肾损伤(AKI)显着相关。无/轻度AKI儿童的中位磷水平为6.4mg/dL,重度AKI儿童的中位磷水平为10.5mg/dL(p=0.0375)。CKRT前血清尿酸水平与AKI无关。所有的孩子都出院了,一年生存率为90%。
■CKRT对于患有严重TLS的恶性血液病儿童是安全的,并在6-12小时内逆转代谢紊乱。大多数患者在开始CKRT时出现AKI,但不需要长期肾脏替代疗法。CKRT开始前的高磷血症与AKI的高风险相关。
UNASSIGNED: Tumor lysis syndrome (TLS) is often diagnosed in children with hematological malignancies and can be life threatening due to metabolic disturbances. Continuous renal replacement therapy (CKRT) can reverse these disturbances relatively quickly when conventional medical management fails. Our objective was to investigate the benefit of CKRT in the management of TLS in children admitted to the intensive care unit with hematologic malignancies. In addition, we sought to assess risk factors for acute kidney injury (AKI) in the setting of TLS.
UNASSIGNED: Retrospective review of all children admitted to the intensive care unit with TLS who received CKRT from January 2012 to August 2022.
UNASSIGNED: Among 222 children hospitalized with TLS from January 2012 to August 2022, 20 (9%) underwent CKRT to manage TLS in the intensive care unit. The patients\' median age was 13 years (range 3-17 y), and most were males (18/20). T-cell acute lymphoblastic leukemia was the most common diagnosis (n=10), followed by acute myeloid leukemia (n=4), Burkitt lymphoma (n=4), and B-cell acute lymphoblastic leukemia (n=2). Five patients required mechanical ventilation, and 2 required vasopressors. The most common indication for CKRT was hyperphosphatemia, followed by, hyperuricemia, and hyperkalemia. All metabolic abnormalities corrected within 12 h of initiation of CKRT. CKRT courses were brief, with a median duration of 2 days (range 1-7 days). Having higher serum phosphorus levels 12 h preceding CKRT was significantly associated with severe acute kidney injury (AKI). The median phosphorus level was 6.4 mg/dL in children with no/mild AKI and 10.5 mg/dL in children with severe AKI (p=0.0375). Serum uric acid levels before CKRT were not associated with AKI. All children survived to hospital discharge, and the one-year survival rate was 90%.
UNASSIGNED: CKRT is safe in children with hematologic malignancies with severe TLS and reverses metabolic derangements within 6-12 h. Most patients had AKI at the initiation of CKRT but did not require long-term kidney replacement therapy. Hyperphosphatemia before initiation of CKRT is associated with higher risk of AKI.