Continuous Renal Replacement Therapy in Neonates

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 neonatespecific 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.