Haemofiltration therapy

This review provides a practical guide to haemofiltration (HF) in children. HF is used predominantly in paediatric intensive care units (PICUs) as one of the modalities of renal replacement therapy (RRT). Its use has expanded beyond the narrow scope of treatment for acute renal failure (ARF) to include fluid removal in patients with massive capillary leak, coagulopathies and also toxin removal in inborn errors of metabolism. The main advantage of using HF is to provide continuous solute clearance and fluid removal, in a controlled manner. This makes it the preferred RRT for patients with cardiovascular instability and hypotension. The basic principles of HF are similar for adults and children. Vascular access is critical and safer machines have been developed for volumetric control. However, nursing knowledge and expertise is essential and there needs to be close collaboration between PICU and nephrology staff. Randomized trials of HF treatment in children have not been undertaken but improved survival has been linked to intensity of HF and fluid removal.