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Renal Replacement Therapy in the Critically Ill Child
Claire A Westrope1, Sarah Fleming2, Melpo Kapetanstrataki2
1Paediatric Intensive care Unit, University Hospitals Leicester NHS Trust, Leicester, United Kingdom.
Insights
This study analyzed renal replacement therapy (RRT) in UK pediatric intensive care units (PICUs). Overall survival was 73.8%, with factors like age and RRT type influencing outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Epidemiology
Background:
- Renal replacement therapy (RRT) is crucial for critically ill children.
- Limited population-based data exists on RRT use and outcomes in pediatric intensive care units (PICUs).
Purpose of the Study:
- To comprehensively describe RRT utilization and associated outcomes in critically ill children across the United Kingdom.
- To identify factors influencing survival in this patient group.
Main Methods:
- Retrospective observational study using prospectively collected data from the Pediatric Intensive Care Audit Network (PICANet) database.
- Inclusion of children (<16 years) admitted to UK PICUs between 2005 and 2012 who received RRT.
- Extraction of individual-level data on demographics, diagnosis, RRT modality, duration, PICU stay, and survival.
Main Results:
- 2.9% (3,825/129,809) of PICU admissions received RRT across 30 centers.
- Overall survival to PICU discharge was 73.8%, higher than previous reports.
- Mortality risk was associated with younger age (neonates), peritoneal dialysis use, longer RRT duration, and primary diagnosis (lowest survival in liver disease).
Conclusions:
- This study provides a large UK-based cohort analysis of pediatric RRT use and outcomes.
- Key factors influencing survival include age, RRT modality, duration, and underlying diagnosis.
- Findings will inform future clinical trial design for critically ill children requiring RRT.
Objectives:
Although renal replacement therapy is widely used in critically ill children, there have been few comprehensive population-based studies of its use. This article describes renal replacement therapy use, and associated outcomes, in critically ill children across the United Kingdom in the largest cohort study of this patient group.
Design:
A retrospective observational study using prospectively collected data.
Setting:
Data from the Pediatric Intensive Care Audit Network database which collects data on all children admitted to U.K. PICUs.
Patients:
Children (< 16 yr) in PICU who received renal replacement therapy between January 1, 2005, and December 31, 2012, were identified.
Interventions:
Individual-level data including age, underlying diagnosis, modality (peritoneal dialysis and continuous extracorporeal techniques [continuous renal replacement therapy]), duration of renal replacement therapy, PICU length of stay, and survival were extracted.
Measurements And Main Results:
Three-thousand eight-hundred twenty-five of 129,809 PICU admissions (2.9%) received renal replacement therapy in 30 of 33 centers. Volumes of renal replacement therapy varied considerably from 0% to 8.6% of PICU admissions per unit, but volume was not associated with patient survival. Overall survival to PICU discharge (73.8%) was higher than previous reports. Mortality risk was related to age, with lower risk in older children compared with neonates (odds ratio, 0.6; 95% CI, 0.5-0.8) although mortality did not increase over the age of 1 year; mode of renal replacement therapy, with lower risk in peritoneal dialysis than continuous renal replacement therapy methodologies (odds ratio, 0.7; 0.5-0.9); duration of renal replacement therapy (odds ratio, 1.02/d; 95% CI, 1.01-1.04); and primary diagnosis, with the lowest survival in liver disease patients (53.9%).
Conclusions:
This study describes current renal replacement therapy use across the United Kingdom and associated outcomes. We describe a number of factors associated with outcome, including age, underlying diagnosis, and renal replacement therapy modality which will need to be factored into future trial design.
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