Hemodialysis Emergencies in Pediatric Hemodialysis Unit and Pediatric Intensive Care Unit

Background: Multiple reason are related to acute kidney injury (AKI) and acute renal failure (ARF) who needed hemodialysis emergencies (HDE) in pediatric intensive care.

Objective: Describe characteristics epidemiological, clinical, biological and etiological of pediatric patient undergoing HDE.

Methods: We conducted in this prospective study from mai 2017 to october 2019 in our pediatric hemodialysis unit at pediatric intenve care of the university hospital center of Oran, we collected all children aged 6 months to 18 years in children underwent at least one session of HDE. We excluded the habituel chronic dialysis children of our unit.

Results: Forty nine children were included for HDE with median age 72 months old (range:6-180) and a sex ratio M/F at 2.76 (36/13). Antecedents of patient were Hypertension 4 (8,2%), Diabete 5 (10,2%), AKI were found in 36 patients with (73,5%) and ARF in 13 patients (26.5%). Etiologies related to AKI were : Multiple Organe Failure 11 (30,5%), Tumoral lysis 10 (27,8%), Ketoacidosis 3 (8,3%), oncological disease 3 (8,3%), atypical hemolytic uremic syndrome 3 (8,3%), hemolytic uremic syndrome 2 (5,5%), poisoning 2 (5,5%), crush syndrome 1 (2,8%) hemorrhagic shock 1 (2,8%). HDE indications were hyperkalemia in 27 (55,1%), metabolic acidosis in 19 (38,8%), Uremic signs in 11(22.4%), acute pulmonary edema in 2 (4,1%). The Majority of patients were anuric 32(65,3%). We reported hypotension in 3 (6,1%), bradycardia in 2 (4,1%) and the necessity to interrupt it in 2 (4,1%)

Conclusions: HDE in pediatric intensive care represente a challange for the intensivists. Hyperkalemia and metabolic acidosis were the main indications. In order to limit a risk of complication of this procedure patients dialysis modalities in emergency situations needed optimization of treatment protocols.