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Factors affecting mortality in children requiring continuous renal replacement therapy in pediatric intensive care
Monika Miklaszewska1, Przemysław Korohoda2, Katarzyna Zachwieja1
1Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Kraków, Poland.
Insights
Fluid overload (FO%) and multi-organ failure (MOF) significantly impact survival in pediatric intensive care unit (PICU) patients receiving continuous renal replacement therapy (CRRT). Higher FO% and MOF are linked to increased mortality in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Renal Replacement Therapy
Background:
- Acute kidney injury (AKI) affects up to 30% of pediatric intensive care unit (PICU) patients, carrying a high mortality risk.
- Continuous renal replacement therapy (CRRT) is a critical intervention for severe AKI in pediatric populations.
Purpose of the Study:
- To identify prognostic factors influencing outcomes in pediatric patients undergoing CRRT.
- To evaluate the association of fluid overload and multi-organ failure with mortality in this cohort.
Main Methods:
- Retrospective, single-center study involving 46 pediatric patients receiving CRRT.
- Logistic regression analysis was employed to assess the impact of various factors on patient survival.
Main Results:
- Fluid overload percentage (FO%) was a significant predictor of survival (OR: 1.030, p = 0.044). Mortality was 67.9% in patients with FO% ≥ 25% versus 33.3% with FO% < 25%.
- Multi-organ failure (MOF) dramatically increased mortality risk (74% with MOF vs. 13% without MOF).
- PICU CRRT patients had significantly higher mortality (54%) compared to the general PICU population (6.5%).
Conclusions:
- Mortality for PICU patients on CRRT is substantially higher (over 8-fold) than the general PICU population.
- Coexisting MOF increases mortality by nearly 6 times, highlighting its critical role in prognosis.
- Children with ≥ 25% fluid overload face more than double the mortality risk compared to those with less fluid overload.
Background:
Acute kidney injury (AKI) occurs in up to 30% of pediatric intensive care unit (PICU) patients and is associated with a high mortality rate.
Objectives:
The objective of the study was to evaluate factors associated with the outcome and to identify the prognostic factors in children receiving continuous renal replacement therapy (CRRT).
Material And Methods:
This was a retrospective, single-center study, including 46 patients.
Results:
Logistic regression analysis demonstrated significant effects on patient survival exerted by the percentage of fluid overload (FO%) (odds ratio (OR): 1.030; p = 0.044). In the group of patients with FO% < 25%, the mortality was 33.3%, and in the FO% ≥ 25% group, the mortality was 67.9% (p < 0.001). The probability of death without multi-organ failure (MOF) was 13%, while with MOF it was 74%. There was no difference in the duration of hospitalization between the CRRT patients (mean: 21.9 days) and the general population of children hospitalized in PICU in the same period (n = 3,255; mean: 25.4 days); however, a significant difference was noted in mortality between the 2 groups of patients (54% vs 6.5%; p < 0.001).
Conclusions:
The mortality of PICU CRRT patients is more than 8-fold higher than the mortality of the total PICU population. Coexisting MOF increases the mortality almost 6 times. The mortality of children with FO% ≥ 25% was more than 2-fold higher than the mortality of children with FO% < 25%.
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