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Prognosis in critically ill children requiring continuous renal replacement therapy

Carmen Fernández1, Jesús López-Herce, Jose C Flores

  • 1Pediatric Intensive Care Unit, Gregorio Marañón Hospital, Madrid, Spain.

Pediatric Nephrology (Berlin, Germany)
|July 28, 2005
PubMed

Insights

In critically ill children needing continuous renal replacement therapy, multi-organ failure and hemodynamic instability significantly predict mortality. Standard scoring systems like PRISM and PIM underestimated mortality risk in this cohort.

Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Pediatric Intensive Care

Background:

  • Continuous renal replacement therapy (CRRT) is a life-saving intervention for critically ill children with acute kidney injury.
  • Identifying prognostic factors in this vulnerable population is crucial for optimizing treatment and resource allocation.

Purpose of the Study:

  • To analyze prognostic factors associated with mortality in critically ill children requiring CRRT.
  • To evaluate the predictive accuracy of established scoring systems (PIM, PRISM) in this specific patient group.

Main Methods:

  • Observational prospective study involving 53 critically ill children undergoing CRRT.
  • Analysis of clinical parameters including Pediatric Index of Mortality (PIM), Pediatric Risk of Mortality Score (PRISM), multi-organ failure score, serum lactate, blood pressure, and vasoactive drug use.

Main Results:

  • Overall mortality was 32.1%, with multi-organ failure being the leading cause of death (59%).
  • Nonsurvivors exhibited significantly lower blood pressure, higher requirements for vasoactive drugs (dopamine, epinephrine), elevated PRISM and PIM scores, higher serum lactate, and more organ failures.
  • PRISM and PIM scores underestimated mortality risk. Mean blood pressure <55 mmHg combined with epinephrine dose >0.6 µg/kg/min predicted mortality in 76% of cases.

Conclusions:

  • Prognosis in pediatric CRRT patients is primarily determined by the severity of their clinical condition at therapy initiation, particularly hemodynamic status.
  • Hemodynamic parameters, specifically mean blood pressure and epinephrine dosage, are critical predictors of mortality in this population.

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