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Hospital admissions associated with dehydration in childhood kidney transplantation
Amelia K Le Page1,2, Lilian M Johnstone3,4, Joshua Y Kausman5,6,7
1Department of Nephrology, Monash Children's Hospital, Clayton, VIC, Australia. Amelia.LePage@monashhealth.org.
Insights
Dehydration admissions are common in children post-kidney transplant. Higher fluid intake targets and teenage age increase risk, while enteric feeding tubes may not prevent illness-related dehydration admissions.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Clinical Pediatrics
Background:
- Paediatric kidney transplant recipients face dehydration risks due to impaired kidney function and illness.
- Dehydration can cause creatinine rise, potentially leading to hospital admission in this vulnerable population.
- This study investigates admissions for graft dysfunction linked to dehydration within 12 months post-transplant.
Purpose of the Study:
- To describe hospital admissions for graft dysfunction associated with dehydration in pediatric kidney transplant recipients.
- To identify risk factors contributing to these dehydration-related admissions.
Main Methods:
- Retrospective data extraction from medical records of pediatric patients from two tertiary children's hospitals.
- Descriptive analysis and multiple failure regression to determine factors associated with dehydration-related acute kidney allograft dysfunction admissions.
Main Results:
- 42% of 92 children experienced at least one dehydration admission within 12 months post-transplant.
- Poor fluid intake accounted for nearly half of dehydration admissions.
- Fluid intake targets >100 ml/kg/day (HR 2.04) and teenage age (HR 4.87) were linked to dehydration admissions; enteric feeding tubes (HR 2.18) correlated with illness-related admissions.
Conclusions:
- Dehydration admissions are frequent in the first year after pediatric kidney transplantation.
- Identified risk factors necessitate further research into optimal fluid intake and hydration strategies for transplant recipients and their caregivers.
- Enteric feeding tubes may not fully prevent dehydration admissions related to underlying illness.
Background:
Paediatric kidney transplant recipients may be at a particular risk of dehydration due to poor kidney concentrating capacity and illness associated with poor fluid intake or losses. In this population, creatinine rise may be more likely with relatively mild dehydration, which may trigger hospital admission. This study describes hospital admissions in the first 12 months after transplantation with diagnosis of graft dysfunction associated with dehydration due to illness or poor fluid intake. We assess risk factors for these admissions.
Methods:
Data was extracted from medical records of patients transplanted in two tertiary children hospitals. Following descriptive analysis, multiple failure regression analyses were used to identify factors associated with admission for acute kidney allograft dysfunction associated with dehydration.
Results:
Of 92 children, 42% had at least 1 dehydration admission in the 12 months following transplantation. Almost half of the dehydration admissions were due to poor fluid intake, which accounted for 1/5 of all unplanned hospital admissions. Target fluid intake at first discharge of > 100 ml/kg/day was associated with dehydration admissions of all types (hazard ratio (HR) 2.04 (95% CI 1.13-3.68)). Teen age was associated with poor fluid intake dehydration admissions (HR 4.87 (95% CI 1.19-19.86)), which were more frequent in mid-summer. Use of enteric feeding tube, which correlated with age under 4, associated with contributing illness dehydration admissions (HR 2.18 (95% CI 1.08-4.41)).
Conclusions:
Dehydration admissions in the 12 months following childhood kidney transplantation are common. Highlighted admission risk factors should prompt further study into optimal fluid intake prescription and hydration advice given to children, teenagers, and their carers following kidney transplantation. Use of an enteric feeding tube may not protect patients from admission with dehydration associated with contributing illness. A highger resolution version of the Graphical abstract is available as Supplementary information.
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