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Continuous Kidney Replacement Therapy and Survival in Children and Young Adults: Findings From the Multinational
Michelle C Starr1, Katja M Gist2, Huaiyu Zang2
1Division of Nephrology, Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
Insights
Approximately two-thirds of pediatric and young adult patients survived intensive care unit discharge while receiving continuous kidney replacement therapy (CKRT). Survival was not associated with CKRT prescription details but may be influenced by comorbidities.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Epidemiology
Background:
- Limited data exist on the epidemiology and outcomes of continuous kidney replacement therapy (CKRT) in pediatric and young adult populations.
- Understanding CKRT practices and survival in this demographic is crucial for improving patient care.
Purpose of the Study:
- To describe patient characteristics, CKRT prescriptions, and survival associations in children and young adults receiving CKRT.
- To identify factors influencing outcomes in critically ill pediatric patients requiring renal support.
Main Methods:
- Retrospective multicenter cohort study involving 980 patients (birth to 25 years) across 32 centers from 2015-2021.
- Data collected on CKRT initiation, duration, modality, anticoagulation, and catheter characteristics.
- Descriptive statistics used to analyze patient demographics and outcomes, including survival to intensive care unit (ICU) discharge.
Main Results:
- The median age was 8.8 years, with CKRT initiated a median of 2 days post-ICU admission and lasting 6 days.
- Continuous venovenous hemodiafiltration with citrate anticoagulation was the predominant modality (62%).
- Overall survival to ICU discharge was 64.1%; however, survival was not significantly associated with CKRT dose, filter type, or anticoagulation, though comorbidities appeared to worsen outcomes.
Conclusions:
- Approximately two-thirds of pediatric and young adult patients survived to ICU discharge on CKRT.
- Observed variations in CKRT practices, including increased use of continuous venovenous hemodiafiltration with citrate anticoagulation, did not correlate with survival.
- Further research is needed to explore the impact of comorbidities on outcomes in this patient group.
Rationale & Objective:
There are limited studies describing the epidemiology and outcomes in children and young adults receiving continuous kidney replacement therapy (CKRT). We aimed to describe associations between patient characteristics, CKRT prescription, and survival.
Study Design:
Retrospective multicenter cohort study.
Setting & Participants:
980 patients aged from birth to 25 years who received CKRT between 2015 and 2021 at 1 of 32 centers in 7 countries participating in WE-ROCK (Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Diseases).
Exposure:
CKRT for acute kidney injury or volume overload.
Outcomes:
Death before intensive care unit (ICU) discharge.
Analytical Approach:
Descriptive statistics.
Results:
Median age was 8.8 years (IQR, 1.6-15.0), and median weight was 26.8 (IQR, 11.6-55.0) kg. CKRT was initiated a median of 2 (IQR, 1-6) days after ICU admission and lasted a median of 6 (IQR, 3-14) days. The most common CKRT modality was continuous venovenous hemodiafiltration. Citrate anticoagulation was used in 62%, and the internal jugular vein was the most common catheter placement location (66%). 629 participants (64.1%) survived at least until ICU discharge. CKRT dose, filter type, and anticoagulation were similar in those who did and did not survive to ICU discharge. There were apparent practice variations by institutional ICU size.
Limitations:
Retrospective design; limited representation from centers outside the United States.
Conclusions:
In this study of children and young adults receiving CKRT, approximately two thirds survived at least until ICU discharge. Although variations in dialysis mode and dose, catheter size and location, and anticoagulation were observed, survival was not detected to be associated with these parameters.
Plain-Language Summary:
In this large contemporary epidemiological study of children and young adults receiving continuous kidney replacement therapy in the intensive care unit, we observed that two thirds of patients survived at least until ICU discharge. However, patients with comorbidities appeared to have worse outcomes. Compared with previously published reports on continuous kidney replacement therapy practice, we observed greater use of continuous venovenous hemodiafiltration with regional citrate anticoagulation.
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