Fluid restriction versus volume expansion in children with diarrhea-associated HUS: a retrospective observational study
| Autor: | Guillermo Iglesias, Ana Vargas, Viviana M. Ratto, Manuel D Bilkis, Amalia Braun, Juliana Tello, Pablo Bonany, Emilio Koch, Patricia Jannello, Ezequiel Monteverde |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Diarrhea
Nephrology medicine.medical_specialty medicine.medical_treatment 030232 urology & nephrology 030204 cardiovascular system & hematology Gastroenterology 03 medical and health sciences 0302 clinical medicine Renal Dialysis Seizures Internal medicine medicine Intravascular volume status Humans Child Saline Dialysis Retrospective Studies business.industry Mortality rate Sodium Retrospective cohort study medicine.disease Hemolytic-Uremic Syndrome Pediatrics Perinatology and Child Health Saline Solution medicine.symptom business Hyponatremia |
| Zdroj: | Pediatric Nephrology. 36:103-109 |
| ISSN: | 1432-198X 0931-041X |
| DOI: | 10.1007/s00467-020-04673-6 |
| Popis: | Fifty percent of patients with typical diarrhea-associated hemolytic uremic syndrome (D+HUS) require kidney replacement therapy (KRT). In these patients, dehydration worsens disease prognosis. We evaluated dialysis requirement, presence of seizures, and mortality rate among patients diagnosed with D+HUS treated with volume expansion (VE) versus fluid restriction (FR). Thirty-five patients with D+HUS were enrolled; 16 received VE and 19 were historical patients who received conventional FR. Upon admission or during treatment, neither group presented evidence of fluid overload. The VE group received higher volumes of saline (VE 27 ml/kg [10–30] over a 3-h period vs. FR 0 ml), had higher urine output after 12 h (VE vs. FR: OR 6.2 [1.2–41.6], P = 0.03), and required less dialysis (VE 2 [12.5%, CI 95% 0–29] vs. FR 9 [47.4%, CI 95% 24–70], P = 0.035). The VE group had an absolute risk reduction of 0.34 (CI 95% 0.07–0.63); hence, three patients treated with VE were required to avoid one KRT. VE also corrected initial hyponatremia and maintained serum sodium within normal ranges. No statistical differences were observed regarding number of patients with seizures (P = 0.08) or mortality (P = 1.0). VE markedly reduces the number of patients requiring KRT and keeps serum sodium within a normal range. We propose to initially hydrate every patient with D+HUS and without signs of fluid overload, with 10 ml/kg/h 0.9% saline solution IV, over a 3-h period. Afterwards, if urine output is ≥ 0.5 ml/kg/h, it is recommended to not dialyze and continue IV hydration schedule with isotonic (D5) saline solution, according to their needs. |
| Databáze: | OpenAIRE |
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