신생아의 지속적 신대체요법
Continuous Renal Replacement Therapy in Neonates
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초록
지속적 신대체 요법(continuous renal replacement therapy, CRRT)은 혈액초여과(hemofiltration)에 기반을 둔 투석의한 방법으로 급성신부전이나 다장기 부전 및 선천성 대사이상질환을 가진 신생아 중환자 치료에 사용된다. 혈액투석(hemodialysis)과 혈액초여과(hemofiltration) 또는 두 가지 방법을 함께 사용하는 조합에 따라 다양한 방식의 CRRT 치료가 존재하지만 아직 최적의 모드나 목표 초여과량(ultrafiltration dose) 에 대한 의견이 확립되어 있지 않다. CRRT는 선천성 대사이상질환에서의 급성 고암모니아혈증에서 혈중 암모니아 농도 감소에 복막투석 보다 효과적인 치료방법이지만 CRRT가 대조군 또는 기타 투석방법에 비하여 사망률을 낮추거나 장기적인 신경학적 예후를 향상시키는지에 대하여는 아직 잘 알려져 있지 않다. CRRT는 혈관확보문제, 출혈성 합병증 및 신생아 전용 투석필터 및 도관의 부재 등으로 인하여 아직 신생아 치료에서 일차적인 신대체요법으로 확립되지는 못하였다. 현재 우리나라에서 신생아 CRRT는 몇 개의대규모 센터에서만 시행 가능하며 이마저도 대부분 서울에 국한되어 있는 실정이다. 국내 신생아 진료의 질을 한 단계업그레이드 하기 위하여는 국가적인 환자 이송시스템 지원과 신생아 CRRT를 시행할 수 있는 전문 의료인력의 확보가절실하다.
Abstract
Continuous renal replacement therapy (CRRT) is one of the hemofiltration-based dialysis modalities used in the management of the high risk neonates with acute renal failure, multi-organ dysfunction and inborn errors of metabolism. While there are different types of CRRT (hemodialysis, hemofiltration or both) used in critically ill patients, there is no consensus on the best type or target ultrafiltration dose of CRRT. In the neonates with hyperammonemia secondary to inborn errors of metabolism, CRRT is more efficient in lowering the plasma ammonia concentration than peritoneal dialysis, although no studies have clearly demonstrated the benefits in decreasing the mortality or the long-term neurodevelopmental morbidities. In neonatal care, the role of CRRT as a primary renal replacement therapy is limited by the difficulties in vascular access, bleeding complications and the lack of neonate-specific hemofiltration devices. Currently, neonatal CRRT in Korea is available only in a few large centers, mostly located in Seoul. The nationwide support for the establishment of the patient referral system and the securing of the personnel who are highly experienced in neonatal CRRT may contribute to improving the quality of neonatal care in Korea.
참고문헌 (23)
- Symons JM, "Demographic characteristics of pediatric continuous renal replacement therapy: a report of the prospective pediatric continuous renal replacement therapy registry", Clin J Am Soc Nephrol, 2, pp.732~738 (2007)
- Kellum JA, "The first international consensus conference on continuous renal replacement therapy", Kidney Int, 62, pp.1855~1863 (2002)
- Mehta RL, "Continuous renal replacement therapy in the critically ill patient", Kidney Int, 67, pp.781~795 (2005)
- Yorgin PD, "Continuous renal replacement therapy in neonates and young infants", NeoReviews, 1, pp.e163~e172 (2000)
- Arbeiter AK, "Continuous venovenous haemodialysis (CVVHD) and continuous peritoneal dialysis (CPD) in the acute management of 21 children with inborn errors of metabolism", Nephrol Dial Transplant, 25, pp.1257~1265 (2010)
- Donn SM, "Comparison of exchange transfusion, peritoneal dialysis, and hemodialysis for the treatment of hyperammonemia in an anuric newborn infant", J Pediatr, 95, pp.67~70 (1979)
- Wong KY, "Ammonia clearance by peritoneal dialysis and continuous arteriovenous hemodiafiltration", Pediatr Nephrol, 12, pp.589~591 (1998)
- Rödl S, "Continuous renal replacement therapy with Prismaflex HF20 disposable set in children from 4 to 15 kg", ASAIO J, 57, pp.451~455 (2011)
- Hackbarth R, "The effect of vascular access location and size on circuit survival in pediatric continuous renal replacement therapy: a report from the PPCRRT registry", Int J Artif Organs, 30, pp.1116~1121 (2007)
- Little MA, "Access recirculation in temporary hemodialysis catheters as measured by the saline dilution technique", Am J Kidney Dis, 36, pp.1135~1139 (2000)
- Yorgin PD, "Neonatal hemodialysis and continuous renal replacement therapy", Neo Reviews, 6, pp.e377~e383 (2005)
- Brophy PD, "AN-69 membrane reactions are pHdependent and preventable", Am J Kidney Dis, 38, pp.173~178 (2001)
- Golper TA, "Continuous arteriovenous hemofiltration in acute renal failure", Am J Kidney Dis, 6, pp.373~386 (1985)
- Ronco C, "CA.R.PE.DI.E.M. (Cardio- Renal Pediatric Dialysis Emergency Machine): evolution of continuous renal replacement therapies in infants. A personal journey", Pediatr Nephrol, 27, pp.1203~1211 (2012)
- RENAL Replacement Therapy Study Investigators, "Intensity of continuous renal-replacement therapy in critically ill patients", N Engl J Med, 361, pp.1627~1638 (2009)
- Maxvold NJ, "Amino acid loss and nitrogen balance in critically ill children with acute renal failure: a prospective comparison between classic hemofiltration and hemofiltration with dialysis", Crit Care Med, 28, pp.1161~1165 (2000)
- del Castillo J, "Circuit life span in critically ill children on continuous renal replacement treatment: a prospective observational evaluation study", Crit Care, 12, pp.R93~ (2008)
- Goldstein SL, "Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy", Kidney Int, 67, pp.653~658 (2005)
- Young Bae Sohn, "Continuous renal replacement therapy in neonates weighing less than 3 kg", Korean Journal of Pediatrics, 55(8), pp.286~292 (2012), 대한소아과학회
- Enns GM, "Survival after treatment with phenylacetate and benzoate for urea-cycle disorders", N Engl J Med, 356, pp.2282~2292 (2007)
- Schaefer F, "Dialysis in neonates with inborn errors of metabolism", Nephrol Dial Transplant, 14, pp.910~918 (1999)
- Picca S, "Extracorporeal dialysis in neonatal hyperammonemia: modalities and prognostic indicators", Pediatr Nephrology, 16, pp.862~867 (2001)
- Westrope C, "Continuous hemofiltration in the control of neonatal hyperammonemia: a 10-year experience", Pediatr Nephrol, 25, pp.1725~1730 (2010)