Major Adverse Kidney Events in Pediatric Continuous Kidney Replacement Therapy.

Area of Science:

• Pediatric Nephrology
• Critical Care Medicine
• Renal Replacement Therapy

Background:

• Continuous kidney replacement therapy (CKRT) is vital for critically ill youths.
• Longer-term outcomes post-CKRT in pediatric populations remain under-investigated.
• Understanding adverse kidney events is crucial for improving patient care.

Purpose of the Study:

• To determine the incidence of major adverse kidney events within 90 days (MAKE-90) in pediatric and young adult CKRT patients.
• To identify risk factors associated with MAKE-90, including CKRT liberation patterns.
• To analyze the impact of liberation strategies on patient outcomes.

Main Methods:

• An international, multicenter cohort study using the WE-ROCK registry (2015-2021).
• Included patients aged 0-25 years treated with CKRT for acute kidney injury or fluid overload.
• Assessed clinical characteristics, CKRT parameters, and defined MAKE-90 outcomes.

Main Results:

• MAKE-90 occurred in 65.0% of 969 patients.
• Cardiac comorbidity, longer ICU admission duration before CKRT, and liberation patterns were significant risk factors.
• Successful CKRT liberation within 28 days was associated with significantly lower odds of MAKE-90.

Conclusions:

• Major adverse kidney events are common in youth treated with CKRT.
• Risk factors include cardiac comorbidity, time to CKRT initiation, and liberation strategies.
• Further research into optimal CKRT liberation practices is warranted.