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Acute renal failure in children: etiology, treatment and outcome
Ihab Sakr Shaheen1, Alan R Watson, Ben Harvey
1Children & Young People's Kidney Unit, Nottingham City Hospital, NHS Trust, United Kingdom.
Insights
Pediatric acute renal failure (ARF) patients treated in intensive care units (ICUs) face higher mortality than those in renal units. Early hemofiltration (HF) may impact outcomes in critically ill children with ARF.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Acute renal failure (ARF) in children presents significant management challenges.
- Continuous renal replacement therapies, including hemofiltration (HF), are increasingly utilized in pediatric intensive care units (PICUs).
- Treatment location (pediatric renal unit vs. NICU/PICU) may influence patient outcomes.
Purpose of the Study:
- To prospectively analyze treatment modalities and outcomes for pediatric patients with ARF.
- To compare outcomes between patients treated in a dedicated pediatric renal unit versus intensive care settings (NICU/PICU).
- To assess the impact of different renal replacement therapies on ARF patient outcomes.
Main Methods:
- Prospective data collection over three years on 83 pediatric ARF patients.
- Inclusion of patients from a regional pediatric renal unit, neonatal intensive care units (NICUs), and a PICU.
- Recording of initial treatment modalities (conservative, peritoneal dialysis, hemodialysis, hemofiltration) and outcomes at three months.
Main Results:
- Overall mortality was 20%, with significantly higher deaths in NICU/PICU (35%) compared to the renal unit (3%).
- Hemofiltration (HF) was used in 28% of patients as an initial treatment modality.
- At three months, 49% had normal renal function, 14% had dialysis-dependent disease, and 8% developed chronic renal failure.
Conclusions:
- Isolated ARF in children has a low mortality rate, but ARF as part of multi-organ failure in intensive care settings carries substantial risk.
- Treatment in intensive care areas is associated with significantly higher mortality for pediatric ARF patients.
- Further research is needed to evaluate the specific impact of early hemofiltration in critically ill pediatric ARF patients.
Abstract:
Children with acute renal failure (ARF) may be treated in pediatric renal or intensive care (PICU) units where there is an increasing use of continuous renal replacement therapies such as hemofiltration (HF). Over three years, we prospectively recorded details of all patients with ARF treated both within our regional pediatric renal unit, in two local neonatal intensive care units (NICUs), and one PICU, which are all supported by our institution. Our study included eighty-three ARF patients (43% male) with a median age of 5.7 years (range 1 day - 19.8 years); 41% of patients were < 2 years, 20% 2-5 years, 13% 5-10 years and 26% > 10 years of age. A total of 37 patients (45%) were treated in the renal unit versus 46 (55%) patients in NICU/PICU. The initial treatment modality was conservative in 33%, peritoneal dialysis (PD) in 23%, hemodialysis (HD) in 15%, HF in 28%, and isolated plasmafiltration in one percent of the patients. About 16% of the patients required more than one treatment modality. Outcome data at three months showed normal renal function in 49%, deaths in 20%, dialysis dependent disease in 14%, chronic renal failure (GFR < 60ml/min/1.73m2) in eight percent, and proteinuria and/or hypertension in seven percent of the patients. Only one (3%) death occurred in 37 patients treated in the renal unit compared to 16 deaths in 46 patients (35%) treated in the NICU/PICU. Our findings further confirm the low mortality rate with isolated renal failure and the substantial mortality and renal workload in intensive care areas where renal failure is often part of multi-organ failure. Further prospective studies will be required to analyze the impact of early hemofiltration in such patients.
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