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Published on: August 19, 2020
Outcome of continuous renal replacement therapy in critically ill children: a retrospective cohort study
Tareq Al-Ayed1, Naveed Ur Rahman, Abdullah Alturki
1Dr. Tareq Al-Ayed, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre,, PO Box 3354, Riyadh 11211, Saudi Arabia, T: +96614427763 F: +96614427784, tayaed@kfshrc.edu.sa, ORCID: http://orcid.org/0000-0001-7525-3529.
Insights
Continuous renal replacement therapy (CRRT) in critically ill children resulted in a 50% mortality rate. Hematological diseases, immunodeficiency, and stem cell transplant increased mortality risk, as did septic shock and inotropic support.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Renal Replacement Therapy
Background:
- Continuous renal replacement therapy (CRRT) is the preferred dialysis for critically ill children with acute kidney injury.
- Limited pediatric data exist on CRRT use, particularly in specific regions.
Purpose of the Study:
- To determine the outcomes of CRRT in critically ill children.
- To identify risk factors associated with mortality in this patient population.
Main Methods:
- A retrospective cohort study was conducted in a pediatric intensive care unit.
- Included were critically ill children aged 1-14 years who underwent CRRT between July 2009 and June 2015.
- Data collected included diagnoses, demographics, CRRT indications and modality, and risk factors for mortality.
Main Results:
- The study included 96 children; the mean age was 6.0 years.
- Common indications for CRRT were fluid overload (67.2%) and tumor lysis syndrome (18.8%).
- The overall mortality rate was 50%. Higher mortality was observed in hematological diseases (100%), immunodeficiency (86.6%), and post-stem cell transplant (90.0%). Septic shock and inotropic support were independently associated with mortality.
Conclusions:
- The 50% mortality rate in critically ill children undergoing CRRT highlights significant risks.
- Hematological diseases, immunodeficiency, and stem cell transplantation are associated with substantially increased mortality.
- Septic shock and the need for inotropic support are critical risk factors for mortality in this cohort.
Background:
Continuous renal replacement therapy (CRRT) has become the preferred mode of dialysis to support critically ill children with acute kidney injury. However, there are limited pediatric data on CRRT use, especially in our region.
Objective:
Determine the outcome of CRRT among critically ill children.
Design:
Retrospective cohort study.
Setting:
Pediatric intensive care unit.
Patients And Methods:
The study included critically ill children 1-14 years of age who underwent CRRT from July 2009 to June 2015. We report the underlying diagnosis, demographics, indications and modality of CRRT, and associated risk factors. Statistical analyses were used to identify risk factors associated with mortality.
Main Outcome Measures:
Mortality and associated risk factors with use of CRRT.
Sample Size:
96 RESULTS: The mean age was 6.0 (standard deviation, 4.4) years, with a male preponderance in the age group from 1-10 years which comprised almost 60% of the study group. The most common primary diagnoses were malignancies [37.5% (36/96)] followed by primary renal diseases [19.8% (19/96)], and immunodeficiency [16.7% (16/96)]. The most common indication for CRRT was fluid overload [67.2% (65/96)] followed by tumor lysis syndrome [18.8%(18/96)], and metabolic encephalopathy [9.4%(9/96)]. The median length of CRRT was 66 hours (IQR, 35.5-161.4), with a median average circuit life of 30.9 hours (IQR, 16.4-45.0). The most common CRRT catheter site was the internal jugular vein [77.1% (74/96)], followed by the femoral vein [18.8%(18/96)] with continuous venovenous hemodiafiltration [82.3%(79/96)] being the most common CRRT modality used. The mortality rate among critically ill children requiring CRRT was 50% (48/96). There was an increased mortality rate among children with hematological diseases (100%, 10/10), immunodeficiency (86.6%, 13/16) and in children who had undergone stem cell transplantation (90.0%, 27/30), with the least mortality in primary renal disease (15.8% (3/19). We identified septic shock and use of inotropic support as being independently associated with mortality in a multivariate analysis.
Conclusion:
The overall mortality rate among critically ill children who un.derwent CRRT was 50% with significantly increased mortality among patients with hematological diseases, immunodeficiency, and in children who had undergone stem cell transplantation. Septic shock and use of inotropic support were associated with mortality.
Limitations:
Retrospective and single center data that is not generalizable.
Conflict Of Interest:
None.
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