Beyond Renal Replacement: Advanced Extracorporeal Blood Purification in Pediatric Sepsis
Abstract List
20 Sep 2026
11:55
12:15
I-Jung TsaiTaiwan
Speaker
Beyond Renal Replacement: Advanced Extracorporeal Blood Purification in Pediatric SepsisSepsis and hyperinflammatory syndromes remain leading causes of mortality in critically ill children, frequently complicated by multiorgan dysfunction syndrome and acute kidney injury. While continuous kidney replacement therapy (CKRT) is the cornerstone for managing fluid overload and solute clearance, standard modalities cannot adequately address the underlying dysregulated immune response driven by a profound cytokine storm. Recently, a significant paradigm shift has occurred in critical care nephrology, transitioning from conventional renal support toward advanced extracorporeal blood purification (EBP) techniques. Current literature emphasizes the clinical benefits of actively removing endotoxins and excessive cytokines to restore immune homeostasis. Modalities utilizing hemoadsorption membranes have demonstrated promising outcomes in adult studies, showing rapid hemodynamic stabilization and successful modulation of inflammatory markers in septic shock. However, literature regarding EBP in pediatric populations remains notably sparse. This knowledge gap is largely attributed to the physiological and technical challenges of pediatric care, particularly the high risks of hemodynamic instability associated with large extracorporeal circuit volumes in children weighing less than 10 kilograms. Standardized protocols for pediatric EBP are still lacking, necessitating cautious technical adaptations, such as targeted blood priming strategies. This presentation will review the current literature on EBP in sepsis, explore the physiological rationale behind targeted hemoadsorption, and discuss the practical challenges of applying these therapies in pediatrics. By moving beyond traditional renal replacement, we aim to highlight how integrating advanced blood purification into pediatric CKRT can safely modulate systemic inflammation, potentially improving clinical outcomes for vulnerable critically ill children.