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Clinical Features and Indications Associated with Mortality in Continuous Renal Replacement Therapy for Pediatric
Guntulu Sık1, Asuman Demirbuga2, Seda Günhar3
1Pediatric Intensive Care Unit, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey. drguntulu@hotmail.com.
Insights
Continuous renal replacement therapy (CRRT) in the pediatric intensive care unit (PICU) effectively treats fluid overload and metabolic issues. Early CRRT initiation improves outcomes for critically ill children, positively impacting mortality rates.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Intensive Care
Background:
- Continuous renal replacement therapy (CRRT) is a vital treatment for critically ill pediatric patients.
- Understanding prognostic factors and indications for CRRT in the pediatric intensive care unit (PICU) is crucial for optimizing patient outcomes.
Purpose of the Study:
- To identify prognostic factors and indications for CRRT in the PICU.
- To evaluate the effect of CRRT on mortality in pediatric patients.
Main Methods:
- A retrospective study of 63 patients admitted to the PICU between 2011 and 2014.
- Comparison of demographic data, PRISM scores, vasoactive-inotropic scores, CRRT indications, timing, fluid overload status, CRRT duration, and PICU stay between survivors and non-survivors.
Main Results:
- Overall survival rate was 69.8%. Fluid overload was the most common indication for CRRT (31.7%). Sepsis was associated with decreased survival compared to acute kidney injury and metabolic diseases. Fluid overload correlated with increased mortality, longer CRRT duration, mechanical ventilation, and PICU stay.
- The median CRRT duration was 58 hours. Continuous venovenous hemodiafiltration was the most common modality, with no significant difference between survivor groups.
Conclusions:
- CRRT is effective for fluid overload and metabolic disturbances in critically ill children.
- Early initiation of CRRT, particularly for fluid overload, can improve patient outcomes and positively influence mortality in the PICU.
- CRRT is a valuable treatment modality that should be considered more frequently in pediatric intensive care settings.
Objectives:
To identify prognostic factors and indications in patients receiving continuous renal replacement therapy (CRRT) in the pediatric intensive care unit (PICU), and to demonstrate their effect on mortality.
Methods:
A total of 63 patients admitted between 2011 and 2014 were included in the study. The demographic information, pediatric risk of mortality (PRISM) scores, vasoactive-inotropic score, indication for CRRT, time of starting CRRT, presence of fluid overload, durations of CRRT, and pediatric intensive care unit (PICU) stay were compared between survivors and non-survivors.
Results:
The overall rate of survival was 69,8%. The most common indication for CRRT was fluid overload (31.7%) followed by acute attacks of metabolic diseases (15.9%), and resistant metabolic acidosis (15.9%). The median duration of CRRT was 58 (IQR 24-96) h. The most common CRRT modality was continuous venovenous hemodiafiltration. The CRRT modality was not different between survivors and nonsurvivors. Sepsis, as the diagnosis for admission to intensive care unit was significantly related to decreased survival when compared to acute kidney injury and acute attacks of metabolic diseases. Patients with fluid overload had significantly increased rate of death, CRRT duration, use of mechanical ventilation, and PICU stay.
Conclusions:
The CRRT, can be effectively used for removal of fluid overload, treatment of acute attacks of metabolic diseases, and other indications in critically ill pediatric patients. It has a positive effect on mortality in high-risk PICU patients. This treatment modality can be used more frequently in pediatric intensive care unit with improved patient outcomes, and should be focused on starting therapy in early stages of fluid overload.
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