Data_Sheet_1_PCRRT Expert Committee ICONIC Position Paper on Prescribing Kidney Replacement Therapy in Critically Sick Children With Acute Liver Failure.zip

Management of acute liver failure (ALF) and acute on chronic liver failure (ACLF) in the pediatric population can be challenging. Kidney manifestations of liver failure, such as hepatorenal syndrome (HRS) and acute kidney injury (AKI), are increasingly prevalent and may portend a poor prognosis. The overall incidence of AKI in children with ALF has not been well-established, partially due to the difficulty of precisely estimating kidney function in these patients. The true incidence of AKI in pediatric patients may still be underestimated due to decreased creatinine production in patients with advanced liver dysfunction and those with critical conditions including shock and cardiovascular compromise with poor kidney perfusion. Current treatment for kidney dysfunction secondary to liver failure include conservative management, intravenous fluids, and kidney replacement therapy (KRT). Despite the paucity of evidence-based recommendations concerning the application of KRT in children with kidney dysfunction in the setting of ALF, expert clinical opinions have been evaluated regarding the optimal modalities and timing of KRT, dialysis/replacement solutions, blood and dialysate flow rates and dialysis dose, and anticoagulation methods.

儿科人群急性肝衰竭（acute liver failure, ALF）与慢加急性肝衰竭（acute on chronic liver failure, ACLF）的临床管理颇具挑战。肝衰竭相关肾脏表现，如肝肾综合征（hepatorenal syndrome, HRS）与急性肾损伤（acute kidney injury, AKI），其患病率日益升高，且往往提示预后不良。目前，ALF患儿中AKI的总体发病率尚未明确，部分原因在于此类患者的肾功能精准评估存在难度。由于晚期肝功能不全患者，以及合并休克、肾脏灌注不足的心血管功能受损等危重症状态的患者肌酐生成减少，儿科AKI患者的真实发病率仍可能被低估。肝衰竭继发肾功能不全的现有治疗手段包括保守治疗、静脉补液与肾脏替代治疗（kidney replacement therapy, KRT）。尽管针对ALF临床背景下合并肾功能不全的患儿应用KRT的循证推荐十分匮乏，但目前已有研究对专家临床意见进行了评估，内容涵盖KRT的最优实施方式与时机、透析/置换液、血液与透析液流速及透析剂量，以及抗凝方案。