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Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK)
Shina Menon1, Kelli A Krallman2, Ayse A Arikan3
1Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA.
Insights
The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) study is the largest international registry of pediatric patients receiving continuous renal replacement therapy (CRRT) for acute kidney injury or fluid overload. This study aims to improve CRRT practices and outcomes in children.
Area of Science:
- Pediatric Critical Care Nephrology
- Renal Replacement Therapy
- Acute Kidney Injury Management
Background:
- Continuous renal replacement therapy (CRRT) is crucial for managing acute kidney injury (AKI) and fluid overload (FO) in critically ill children.
- Existing pediatric CRRT data are limited, primarily from small, single-center studies, highlighting the need for large-scale international research.
- Practice patterns and outcomes associated with CRRT in pediatric populations remain incompletely understood.
Purpose of the Study:
- To establish the largest international registry of pediatric patients undergoing CRRT for AKI or FO.
- To describe the epidemiology, CRRT prescription, and liberation patterns in children treated with CRRT.
- To investigate the association of fluid balance, timing of CRRT initiation, and CRRT prescription with clinical and patient-centered outcomes.
Main Methods:
- A multinational, multicenter retrospective study involving 996 children (0-25 years) treated with CRRT for AKI or FO across 32 centers in 7 countries (2018-2021).
- Collection of comprehensive data on demographics, clinical characteristics, CRRT initiation, management during the first 7 days, and liberation.
- Assessment of outcomes including major adverse kidney events at 90 days (mortality, dialysis dependence, persistent kidney dysfunction) and functional outcomes using the functional stats scale.
Main Results:
- The WE-ROCK study enrolled 996 pediatric patients, representing the largest international cohort for CRRT in AKI/FO.
- Detailed data on CRRT practices, fluid management, and patient characteristics were collected across diverse international centers.
- The study established a foundation for analyzing CRRT's impact on major adverse kidney events and functional outcomes in children.
Conclusions:
- The WE-ROCK retrospective study is the largest international registry of pediatric CRRT for AKI/FO.
- This study will significantly enhance understanding of practice heterogeneity and CRRT's association with outcomes in pediatric critical care nephrology.
- Preliminary data generated will inform future interventional trials aimed at optimizing CRRT for children.
Introduction:
Continuous renal replacement therapy (CRRT) is used for the symptomatic management of acute kidney injury (AKI) and fluid overload (FO). Contemporary reports on pediatric CRRT are small and single center in design. Large international studies evaluating CRRT practice and outcomes are lacking. Herein, we describe the design of a multinational collaborative.
Methods:
The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) is an international collaborative of pediatric specialists whose mission is to improve short- and long-term outcomes of children treated with CRRT. The aims of this multicenter retrospective study are to describe the epidemiology, liberation patterns, association of fluid balance and timing of CRRT initiation, and CRRT prescription with outcomes.
Results:
We included children (n = 996, 0-25 years) admitted to an intensive care unit (ICU) and treated with CRRT for AKI or FO at 32 centers (in 7 countries) from 2018 to 2021. Demographics and clinical characteristics before CRRT initiation, during the first 7 days of both CRRT, and liberation were collected. Outcomes include the following: (i) major adverse kidney events at 90 days (mortality, dialysis dependence, and persistent kidney dysfunction), and (ii) functional outcomes (functional stats scale).
Conclusion:
The retrospective WE-ROCK study represents the largest international registry of children receiving CRRT for AKI or FO. It will serve as a broad and invaluable resource for the field of pediatric critical care nephrology that will improve our understanding of practice heterogeneity and the association of CRRT with clinical and patient-centered outcomes. This will generate preliminary data for future interventional trials in this area.
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