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The medical indications guiding discontinuation of RRT in children do not differ from adults, except in those instances where RRT is initiated for pediatric-specific disease, such as inborn errors of metabolism to treat hyperammonemia557 or immediately after surgical correction of congenital heart disease to maintain euvolemia, and/or possibly mitigate the postbypass proinflammatory response.558
Prognosis in children who survive an AKI episode is significantly better than in adults, and many children may have several decades of life expectancy. Askenazi demonstrated nearly 80% 3- to 5-year survival for children discharged after an AKI episode from a tertiary center,569 yet two-thirds of deaths occurred in the first 2 years after discharge, suggesting a high probability of greater life expectancy after that period. In addition, no data exist to define a maximal RRT duration; even data from the Prospective Pediatric CRRT Registry show 35% survival in children receiving CRRT for > 28 days.570 Finally, since pediatric AKI now results more often as a secondary phenomenon from another systemic illness or its treatment,552,553 determination of the overall goals of therapy for children, as in for adults, must take into consideration local standards, patient and family wishes, as well as the probability of recovery of the underlying illness leading to AKI and the need for RRT.
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