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Published on: July 19, 2021
Continuous renal replacement therapy in children: fluid overload does not always predict mortality
Lara de Galasso1, Francesco Emma2, Stefano Picca2
1Nephrology and Dialysis A Unit, "Sapienza" University of Rome, Viale dell'Università, 33, 00185, Rome, Italy. laradegalasso@gmail.com.
Insights
High mortality in critically ill children on continuous renal replacement therapy (CRRT) is linked to diagnosis and illness severity. Fluid overload predicts mortality only in milder pediatric cases receiving CRRT.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Pediatric Oncology
Background:
- Mortality remains high for critically ill children requiring continuous renal replacement therapy (CRRT).
- Fluid overload at CRRT initiation is a suspected predictor of mortality in this vulnerable population.
- Understanding risk factors is crucial for improving outcomes in pediatric intensive care.
Purpose of the Study:
- To identify independent risk factors for mortality in critically ill children undergoing CRRT.
- To investigate the specific association between fluid overload and mortality in different pediatric subgroups.
- To analyze survival rates and their predictors in a pediatric intensive care unit (PICU) cohort.
Main Methods:
- Retrospective single-center analysis of pediatric patients (2000-2012) receiving CRRT.
- Patients classified by primary disease, with survival to PICU discharge as the primary outcome.
- Multiple regression analysis used to determine independent predictors of mortality.
Main Results:
- Overall survival to PICU discharge was 45.8%.
- Independent mortality predictors included onco-hematological disease, severe multiple organ dysfunction syndrome (MODS), and hypotension.
- Fluid overload >10% at CRRT initiation was a negative predictor in children with milder (renal) disease, though not statistically significant across all subgroups.
Conclusions:
- Underlying diagnosis and illness severity are independent risk factors for mortality in pediatric CRRT patients.
- Fluid overload is a significant negative predictor of mortality specifically in children with less severe underlying conditions.
- Further research with larger cohorts may clarify the role of fluid overload in diverse pediatric CRRT populations.
Background:
Mortality among critically ill children requiring continuous renal replacement therapy (CRRT) is high. Several factors have been identified as outcome predictors. Many studies have specifically reported a positive association between the fluid overload at CRRT initiation and the mortality of critically ill pediatric patients.
Methods:
This study is a retrospective single-center analysis including all patients admitted to the pediatric intensive care unit (PICU) of our hospital who received CRRT between 2000 and 2012. One hundred thirty-one patients were identified and subsequently classified according to primary disease. Survival rates, severity of illness and fluid balance differed among subgroups. The primary outcome was patient survival to PICU discharge.
Results:
Overall survival to PICU discharge was 45.8 %. Based on multiple regression analysis, mortality was independently associated with onco-hematological disease [odds ratio (OR) 11.7, 95 % confidence interval (CI) 1.3-104.7; p = 0.028], severe multiple organ dysfunction syndrome (MODS) (OR 5.1, 95 % CI 1.7-15; p = 0.003) and hypotension (OR 11.6, 95 % CI 1.4-93.2; p = 0.021). In the subgroup analysis, a fluid overload (FO) of more than 10 % (FO>10 %) at the beginning of CRRT seems to be a negative predictor of mortality (OR 10.9, 95 % CI 0.78-152.62; p = 0.07) only in children with milder disease (renal patients). Due to lack of statistical power, the independent effect of fluid overload on mortality could not be analyzed in all subgroups of patients.
Conclusions:
In children treated with CRRT the underlying diagnosis and severity of illness are independent risk factors for mortality. The degree of FO is a negative predictor only in patients with milder disease.
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