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Eighteen years experience in pediatric acute dialysis: analysis of predictors of outcome

W K Gong1, T H Tan, P P Foong

  • 1Department of Pediatrics, National University of Singapore, Singapore.

Pediatric Nephrology (Berlin, Germany)
|April 27, 2001
PubMed

Insights

Acute dialysis in pediatric intensive care units showed no significant mortality improvement with newer methods. Factors like young age and mechanical ventilation were linked to poor outcomes in critically ill children.

Area of Science:

  • Pediatric Intensive Care
  • Nephrology
  • Critical Care Medicine

Background:

  • Acute dialysis is crucial for critically ill children.
  • Understanding factors influencing outcomes is essential for improving care.

Purpose of the Study:

  • To review 18 years of acute dialysis experience in a pediatric intensive care unit.
  • To identify predictors of outcome for pediatric acute dialysis.
  • To assess the impact of evolving dialysis modalities on patient outcomes.

Main Methods:

  • Retrospective review of 66 children (1 day to 19 years) undergoing acute dialysis from May 1980 to April 1998.
  • Analysis of factors predicting outcome using univariate and Cox regression.
  • Comparison of outcomes between peritoneal dialysis and continuous hemodiafiltration (CHDF).

Main Results:

  • Mortality was 63.9% with peritoneal dialysis and 73.3% with CHDF.
  • Younger age (<1 year), coma, acute tubular necrosis, disseminated intravascular coagulopathy, assisted ventilation, and hypotension were associated with poor outcomes.
  • Mechanical ventilation (RR 5.96) and age <1 year (RR 2.00) significantly increased mortality risk.

Conclusions:

  • Despite the shift towards CHDF, no significant improvement in mortality was observed.
  • Increased mortality may be attributed to managing a sicker patient population.
  • Younger age and mechanical ventilation remain significant predictors of poor outcomes in pediatric acute dialysis.

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