Continuous Renal-Replacement Therapy in Critically Ill Children: Practice Changes and Association With Outcome

Area of Science:

• Pediatric critical care medicine
• Nephrology
• Renal replacement therapy

Background:

• Continuous renal-replacement therapy (CRRT) is a vital treatment for critically ill children with kidney dysfunction.
• Practice patterns and outcomes associated with CRRT in pediatric intensive care units (PICUs) can evolve over time.
• Evaluating these changes is crucial for optimizing patient care and improving survival rates.

Purpose of the Study:

• To assess changes in CRRT practices and their impact on outcomes in a pediatric intensive care unit over a decade.
• To identify specific practice modifications, such as timing of initiation and anticoagulation methods, that correlate with improved patient survival.
• To provide insights into quality improvement initiatives for CRRT in critically ill pediatric populations.

Main Methods:

• Retrospective analysis of a single-center PICU cohort from January 2010 to December 2019.
• Inclusion criteria: critically ill children receiving CRRT.
• Comparison of two periods: 2010-2014 and 2015-2019, analyzing initiation time, fluid overload, anticoagulation, and survival rates.

Main Results:

• A significant reduction in CRRT initiation time exceeding 24 hours was observed in the latter period (32.73% vs. 60.60%).
• Lower percentages of fluid overload at CRRT initiation (3.8% vs. 12.1%) and increased use of regional citrate anticoagulation (100% vs. 22.7%) were noted in the later period.
• The ICU survival rate significantly improved in the latter period (58.7% vs. 36.4%). Subgroup analyses indicated better survival with early CRRT initiation (<24 hours), regional citrate anticoagulation, and less than 10% fluid overload.

Conclusions:

• Survival rates for pediatric patients receiving CRRT have improved over the past decade at this center.
• Early CRRT initiation, reduced fluid overload, and the use of regional citrate anticoagulation appear to be associated with improved outcomes.
• Continuous evaluation and quality improvement efforts for CRRT in critically ill children are essential.