1. Consensus guidelines for management of hyperammonaemia in paediatric patients receiving continuous kidney replacement therapy.
- Author
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Raina R, Bedoyan JK, Lichter-Konecki U, Jouvet P, Picca S, Mew NA, Machado MC, Chakraborty R, Vemuganti M, Grewal MK, Bunchman T, Sethi SK, Krishnappa V, McCulloch M, Alhasan K, Bagga A, Basu RK, Schaefer F, Filler G, and Warady BA
- Subjects
- Arginine therapeutic use, Carnitine therapeutic use, Child, Child, Preschool, Delphi Technique, Diet, Protein-Restricted, Humans, Hybrid Renal Replacement Therapy, Hyperammonemia metabolism, Infant, Infant, Newborn, Parenteral Nutrition methods, Phenylacetates therapeutic use, Phenylbutyrates therapeutic use, Practice Guidelines as Topic, Renal Dialysis methods, Sodium Benzoate therapeutic use, Urea Cycle Disorders, Inborn metabolism, Vitamin B Complex therapeutic use, Continuous Renal Replacement Therapy methods, Hyperammonemia therapy, Peritoneal Dialysis methods, Urea Cycle Disorders, Inborn therapy
- Abstract
Hyperammonaemia in children can lead to grave consequences in the form of cerebral oedema, severe neurological impairment and even death. In infants and children, common causes of hyperammonaemia include urea cycle disorders or organic acidaemias. Few studies have assessed the role of extracorporeal therapies in the management of hyperammonaemia in neonates and children. Moreover, consensus guidelines are lacking for the use of non-kidney replacement therapy (NKRT) and kidney replacement therapies (KRTs, including peritoneal dialysis, continuous KRT, haemodialysis and hybrid therapy) to manage hyperammonaemia in neonates and children. Prompt treatment with KRT and/or NKRT, the choice of which depends on the ammonia concentrations and presenting symptoms of the patient, is crucial. This expert Consensus Statement presents recommendations for the management of hyperammonaemia requiring KRT in paediatric populations. Additional studies are required to strengthen these recommendations.
- Published
- 2020
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