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Outcomes of critically ill children requiring continuous renal replacement therapy
Leslie W Hayes1, Robert A Oster, Nancy M Tofil
1Division of Critical Care, The Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL 35233, USA. lhayes@peds.uab.edu
Insights
Fluid overload greater than 20% in pediatric intensive care unit (PICU) patients requiring continuous renal replacement therapy (CRRT) is linked to higher mortality. This condition also prolongs recovery and hospital stays for survivors.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Renal Replacement Therapy
Background:
- Acute kidney injury (AKI) in the pediatric intensive care unit (PICU) carries a high mortality rate exceeding 50%.
- Previous research suggests that fluid overload (FO) below 20% may be associated with improved survival in AKI patients.
Purpose of the Study:
- To evaluate factors associated with mortality in pediatric patients undergoing continuous renal replacement therapy (CRRT).
- To assess secondary outcomes related to fluid overload in critically ill children with AKI.
Main Methods:
- Retrospective chart review of pediatric patients who received CRRT between January 2000 and September 2005.
- Analysis of patient demographics, fluid overload percentage (%FO), comorbidities, and clinical outcomes.
Main Results:
- Overall survival was 55.3% among 76 patients requiring CRRT.
- A fluid overload (FO) of 20% or greater at CRRT initiation was significantly associated with higher mortality (22.3% vs 7.3% in nonsurvivors vs survivors).
- Sepsis and multiple organ dysfunction syndrome (MODS) were also strongly linked to mortality; FO >20% prolonged mechanical ventilation, PICU stay, and hospitalization in survivors.
Conclusions:
- In pediatric AKI patients requiring CRRT, sepsis, MODS, and FO >20% are significant predictors of mortality.
- Excessive fluid overload (>20%) in survivors requiring CRRT is associated with prolonged recovery times and extended hospital stays.
Purpose:
Acute kidney injury in the pediatric intensive care unit (PICU) is associated with significant morbidity, with continued mortality greater than 50%. Previous studies have described an association between percentage of fluid overload (%FO) less than 20% and improved survival. We reviewed our continuous renal replacement therapy (CRRT) experience to evaluate for factors associated with mortality as well as secondary outcomes.
Materials And Methods:
This is a retrospective chart review of pediatric CRRT intensive care unit patients from January 2000 to September 2005.
Results:
Seventy-six admissions required CRRT during the study period. Overall survival was 55.3%. Median patient age was 5.8 years (range, 0-18.9). Median %FO at the time of CRRT initiation was 7.3% in survivors vs 22.3% in nonsurvivors (P = .0001). Presence of sepsis was significantly associated with mortality (P = .0001). All nonsurvivors had multiple organ dysfunction syndrome (MODS); only 69% of survivors had MODS (P = .0003). For survivors, there was a significant relationship between %FO and time to renal recovery (P = .0038). Greater %FO was also associated with significantly prolonged days of mechanical ventilation (P = .0180), PICU stay (P = .0425), and duration of hospitalization (P = .0123).
Conclusions:
For patients with acute kidney injury who require CRRT, the presence of sepsis, MODS, and FO greater than 20% at the time of CRRT initiation are significantly associated with higher mortality. In addition, we report that duration of mechanical ventilation, PICU stay, hospitalization, and time to renal recovery were all significantly prolonged for survivors who had FO greater than 20%.
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