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Characteristics and outcomes of children ≤ 10 kg receiving continuous kidney replacement therapy: a WE-ROCK study
Shina Menon1,2, Michelle C Starr3, Huaiyu Zang4
1Department of Pediatrics, Center for Academic Medicine, Pediatric Nephrology, Lucile Packard Children's Hospital, Stanford University, MC-5660, 453 Quarry Rd, Palo Alto, CA, 94304, USA. shinam@stanford.edu.
Insights
Pediatric intensive care unit (ICU) mortality for children weighing ≤10 kg receiving continuous kidney replacement therapy (CKRT) has decreased. However, high rates of 90-day adverse kidney events emphasize the need for ongoing monitoring in these critically ill children.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Continuous kidney replacement therapy (CKRT) is a vital treatment for acute kidney injury (AKI) and fluid overload (FO) in critically ill children weighing ≤10 kg.
- Previous studies reported high intensive care unit (ICU) mortality rates (57%) in this vulnerable pediatric population.
- Contemporary data on outcomes for these young patients receiving CKRT are limited.
Purpose of the Study:
- To evaluate characteristics associated with ICU mortality in children weighing ≤10 kg undergoing CKRT.
- To assess the incidence of major adverse kidney events at 90 days (MAKE-90) in this cohort.
- To compare contemporary outcomes with historical data from the prospective pediatric CRRT (ppCRRT) registry.
Main Methods:
- Retrospective analysis of the multinational, observational Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) registry (2015-2021).
- Inclusion criteria: children aged 0-25 years receiving CKRT for AKI or FO, with a focus on those ≤10 kg at hospital admission.
- Outcomes assessed: ICU mortality and MAKE-90 (death, persistent kidney dysfunction, or dialysis within 90 days).
Main Results:
- A cohort of 210 pediatric patients (median age 0.53 years) was analyzed.
- ICU mortality was 46.5%, a decrease from historical controls, but MAKE-90 occurred in 72% of patients.
- Higher Pediatric Logistic Organ Dysfunction score (PELOD-2) at CKRT initiation was linked to increased odds of ICU mortality and MAKE-90.
Conclusions:
- Contemporary CKRT use in children ≤10 kg shows improved ICU survival compared to the ppCRRT registry.
- The high incidence of MAKE-90 underscores significant long-term morbidity and the critical need for close post-discharge follow-up.
- Pediatric logistic organ dysfunction score (PELOD-2) is a key predictor of adverse outcomes in this population.
Background:
Continuous kidney replacement therapy (CKRT) is often used for acute kidney injury (AKI) or fluid overload (FO) in children ≤ 10 kg. Intensive care unit (ICU) mortality in children ≤ 10 kg reported by the prospective pediatric CRRT (ppCRRT, 2001-2003) registry was 57%. We aimed to evaluate characteristics associated with ICU mortality using a contemporary registry.
Methods:
The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) registry is a retrospective, multinational, observational study of children and young adults aged 0-25 years receiving CKRT (2015-2021) for AKI or FO. This analysis included patients ≤ 10 kg at hospital admission.
Primary And Secondary Outcomes:
ICU mortality and major adverse kidney events at 90 days (MAKE-90) defined as death, persistent kidney dysfunction, or dialysis within 90 days, respectively.
Results:
A total of 210 patients were included (median age 0.53 years (IQR, 0.1, 0.9)). ICU mortality was 46.5%. MAKE-90 occurred in 150/207 (72%). CKRT was initiated at a median 3 days (IQR 1, 9) after ICU admission and lasted a median 6 days (IQR 3, 16). On multivariable analysis, pediatric logistic organ dysfunction score (PELOD-2) at CKRT initiation was associated with increased odds of ICU mortality (aOR 2.64, 95% CI 1.68-4.16), and increased odds of MAKE-90 (aOR 2.2, 95% CI 1.31-3.69). Absence of comorbidity was associated with lower MAKE-90 (aOR 0.29, 95%CI 0.13-0.65).
Conclusions:
We report on a contemporary cohort of children ≤ 10 kg treated with CKRT for acute kidney injury and/or fluid overload. ICU mortality is decreased compared to ppCRRT. The extended risk of death and morbidity at 90 days highlights the importance of close follow-up.
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