ORIGINAL ARTICLE Metabolic disturbances following the use of inadequate solutions for hemofiltration in acute renal failure Demet Demirkol Soysal & Metin Karaböcüoğlu & Agop Çıtak & Raif Üçsel & Nedret Uzel & Ahmet Nayır Received: 11 May 2006 / Revised: 17 September 2006 / Accepted: 23 October 2006 / Published online: 5 December 2006 # IPNA 2006 Abstract Continuous renal replacement therapy (CRRT) has become an important supportive therapy for critically ill children with acute renal failure. In Turkey, commercially available diafiltration and replacement fluids cannot be found on the market. Instead, peritoneal dialysis fluids for dialysis and normal saline as replacement fluid are used. The first objective of this study was to examine metabolic complications due to CRRT treatments. The second objec- tive was to determine demographic characteristics and outcomes of patients who receive CRRT. We did a retrospective chart review of all pediatric patients treated with CRRT between February and December 2004. Thirteen patients received CRRT; seven survived (53.8%). All patients were treated with continuous venovenous hemodia- filtration. Median patient age was 71.8±78.8 (1.5–180) months. Hyperglycemia occurred in 76.9% (n =10), and metabolic acidosis occurred in 53.8% (n =7) of patients. Median age was younger (48.8 vs.106.2 months), median urea level (106.2 vs. 71 mg/dl) and percent fluid overload (FO) (17.2% vs. 7.6%, respectively) were higher, and CRRT initiation time was longer (8.6 vs 5.6 days) in nonsurvivors vs. survivors for all patients, although these were not statistically significant. CRRT was stopped in all survivors, and four nonsurvivors (67%) were on renal replacement therapy at the time of death. Hyperglycemia and metabolic acidosis were frequently seen in CRRT patients when commercially available diafiltration fluids were not available. Using peritoneal dialysis fluid as dialysate is not a preferable solution. Early initiation of CRRT offered survival benefits to critically ill pediatric patients. Mortality was associated with the primary disease diagnosis. Keywords Continuous renal replacement therapy . Metabolic disturbances . Pediatrics . Critical care unit . Survival Introduction Acute renal failure (ARF) develops in 10–23% of patients admitted to intensive care units [1]; 70% of these require renal replacement therapy (RRT) to sustain life [2]. There are three main modalities of RRT for ARF treatment: peritoneal dialysis, traditional intermittent hemodialysis (IHD), and continuous renal replacement therapy (CRRT). Since CRRT occurs on a continuous basis and allows for slower fluid removal rates than IHD, CRRT is a therapy that is more suitable for fluid removal in critically ill patients with hemodynamic instability. Surveys within the pediatric nephrology literature have confirmed clinicians’ experience of a trend away from IHD and peritoneal dialysis toward CRRT [3]. However, since the method requires large volumes of replacement or dialysis fluid, the composition of the fluid is of utmost importance in this age group. We have been using CRRT in our pediatric intensive care unit since 2003. In our country, commercial diafiltra- tion or replacement fluids or fluids prepared by the pharmacy department are unavailable. We therefore use commercially available 1.36% peritoneal dialysis (PD) Pediatr Nephrol (2007) 22:715–719 DOI 10.1007/s00467-006-0380-3 D. D. Soysal : M. Karaböcüoğlu : A. Çıtak : R. Üçsel : N. Uzel Department of Pediatric Intensive Care, Istanbul Medical Faculty, Istanbul, Turkey A. Nayır(*) Department of Pediatric Nephrology, Istanbul Medical Faculty, Millet Cad, Fındıkzade, 34390 Istanbul, Turkey e-mail: nayir@ttnet.net.tr