Related Experiment Video
Updated: Oct 2, 2026
A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
Pediatric acute renal failure: outcome by modality and disease
T E Bunchman1, K D McBryde, T E Mottes
1Division of Pediatric Nephrology and Transplantation, Children's Hospital of Alabama, University of Alabama at Birmingham, 35233, USA. tbunchman@peds.uab.edu
Insights
Pressor use, underlying diagnosis, and hemodynamic stability are key predictors of survival in children requiring renal replacement therapy (RRT). RRT modality did not significantly impact survival rates.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Renal replacement therapy (RRT) is crucial for managing acute renal failure (ARF) in children.
- Understanding factors influencing survival in pediatric ARF is essential for improving patient outcomes.
Purpose of the Study:
- To retrospectively analyze factors affecting survival in children undergoing RRT.
- To compare the impact of different RRT modalities on patient survival.
Main Methods:
- Retrospective review of 226 children who received RRT between 1992 and 1998.
- Analysis of RRT modalities including hemofiltration (HF), hemodialysis (HD), and peritoneal dialysis (PD).
- Evaluation of factors such as blood pressure, pressor use, and diagnosis on patient survival.
Main Results:
- Survival rates were significantly influenced by blood pressure, pressor use, and diagnosis.
- Hemodynamic stability (normal/high blood pressure, no pressor use) correlated with higher survival rates.
- While hemodialysis showed higher survival (81%) compared to HF (40%) and PD (49%), pressor use was the strongest predictor of survival.
Conclusions:
- Pressor use is the most significant predictor of survival in children requiring RRT, outweighing the RRT modality.
- Patient survival in pediatric ARF requiring RRT is comparable to adults.
- Underlying diagnosis and hemodynamic stability are critical determinants of survival in pediatric ARF.
Abstract:
Two hundred and twenty-six children who underwent renal replacement therapy (RRT) from 1992 to 1998 were retrospectively reviewed. The mean age, at the onset of RRT, was 74+/-11.7 months and weight was 25.3+/-9.7 kg. RRT therapies included hemofiltration (HF; n=106 children for an average of 8.7+/-2.3 days), hemodialysis (HD; n=61 children for an average of 9.5+/-1.7 days), and peritoneal dialysis (PD; n=59 children for an average of 9.6+/-2.1 days). Factors influencing patient survival included: (1) low blood pressure (BP) at onset of RRT (33% survival with low BP, vs. 61% with normal BP, vs 100% with high BP; P<0.05), (2) use of pressors anytime during RRT (35% survival in those on pressors vs. 89% survival in those not requiring pressors; P<0.01), (3) diagnosis (primary renal failure with a high likelihood of survival vs secondary renal failure; P<0.05), (4) RRT modality (40% survival with HF, vs. 49% survival with PD, vs. 81% survival with HD; P<0.01 HD vs PD or HF), and (5) pressor use was significantly higher in children on HF (74%) vs HD (33%) or PD (81%; P<0.05 HD vs HF or PD). In conclusion, pressor use has the greatest prediction of survival, rather than RRT modality. Patient survival in children with the need for RRT for ARF is similar to in adults and, as in adults, is best predicted by the underlying diagnosis and hemodynamic stability.
Related Concept Videos
01:20Acute Kidney Injury V: Interprofessional Care
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:22Acute Kidney Injury I: Introduction
01:29Acute Kidney Injury II: Pathophysiology
01:29Acute Kidney Injury III: Clinical Manifestations
01:28Chronic Kidney Disease III: Interprofessional Care