Modalities of Renal Replacement Therapy in Pediatric Acute Kidney Injury

Study Overview
=================
Brief Summary
-----------------
Limited prospective data is available to compare morbidity and mortality between renal replacement modalities in pediatric acute renal failure. In the absence of clear standard of care, the choice of the extra renal replacement therapy modality is subject to clinical judgement, practical aspects, and costs. This study will supply important data about usual modalities of pediatric acute extra renal replacement therapy and their impact on patient outcome and renal recovery. An obvious next step will be to conduct a randomized controlled trial comparing the different strategies.

Detailed Description
-----------------
In children, there are limited data on extra renal replacement therapy. Pediatric studies are often retrospective, or often limited to specific disease processes or specific extra renal therapy. The lack of large studies including different usual modalities in pediatrics limits any formal recommendation on use in relation to patient outcomes, including renal recovery and mortality. Some of the issues that need consideration are the choice of dialysis modality (including Intermittent Hemodialysis, Continuous Renal Replacement Therapies, and Peritoneal Dialysis), the indications for and timing of dialysis intervention, the dose of dialysis and their effects on outcomes from acute kidney injury in children. This study will supply important data about pediatric acute extra renal replacement therapy, including the epidemiology of pediatric acute kidney injury leading to extra renal replacement therapy, the variety of the treatment modalities, and their effects on the course of the disease.

Official Title
-----------------
Modalities of Renal Replacement Therapy in Pediatric Acute Kidney Injury

Conditions
-----------------
Kidney Failure, Acute

Intervention / Treatment
-----------------
* Procedure: acute extra renal replacement therapy


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Age < 18 years, including the newborn ; Acute kidney injury as defined by pRIFLE classification requiring extra renal replacement therapy, whatever is the method. Exclusion Criteria: Treatment by extra renal replacement therapy for terminal renal failure; History of renal transplantation; Extra renal replacement therapy for an inborn errors of metabolism without acute renal failure; Extra renal replacement therapy in the context of a drug intoxication without acute renal failure; Treatment by technique in MARS (Molecular Adsorbent Recirculating System); Modified ultrafiltration during surgery.

Ages Eligible for Study
-----------------
Maximum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| extrarenal replacement therapy<br>Intermittent Hemodialysis, Continuous Renal Replacement Therapies, and Peritoneal Dialysis | Procedure: acute extra renal replacement therapy<br>* usual modalities of pediatric acute extra renal replacement therapy : Intermittent Hemodialysis, Continuous Renal Replacement Therapies, and Peritoneal Dialysis<br>* Other names: Non applicable.;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| extra renal replacement therapy | To describe usual modalities of pediatric acute extra renal replacement therapy including Intermittent Hemodialysis, Continuous Renal Replacement Therapies, and Peritoneal Dialysis. | at day 60 +/- 7 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Current incidence | Current incidence of the use of extra renal replacement therapy in pediatric acute renal failure | at day 60 +/- 7 | 
| etiologies | Acute kidney injury etiologies leading to extra renal replacement therapy | at day 0 | 
| Risk factors of mortality and non recovery of the renal function | Risk factors of mortality and non recovery of the renal function at day 60 in child acute kidney injur treated by extra renal replacement therapy (including, among others, the choice of dialysis modality (i.e. Intermittent Hemodialysis, Continuous Renal Replacement Therapies, and Peritoneal Dialysis), the indications for and timing of dialysis intervention, and the dose of dialysis). Urea, blood pressure, creatinine, report proteinuria / creatinuria, renal disease, acute graft | at day 60 | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
pediatric, acute renal failure, acute extra renal replacement therapy, Intermittent Hemodialysis, Continuous Renal Replacement Therapies, Peritoneal Dialysis