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Thrombocytopenia in Children and Young Adults Undergoing Continuous Renal Replacement Therapy: A WE-ROCK Study
Abby Basalely1, Katja M Gist2, Natalja L Stanski2
1Division of Pediatric Nephrology, Cohen Children's Medical Center, New Hyde Park, New York, USA.
Insights
Thrombocytopenia is common before and during continuous renal replacement therapy (CRRT) in children and is linked to severe illness. Monitoring platelet counts is crucial as low platelets may indicate poor prognosis.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Hematology
Background:
- Thrombocytopenia (low platelet count) in adults on continuous renal replacement therapy (CRRT) correlates with mortality.
- Limited pediatric data exists on the impact of thrombocytopenia during CRRT.
Purpose of the Study:
- To evaluate the association between pre-CRRT thrombocytopenia and platelet decline during CRRT with patient outcomes in pediatric populations.
- To identify factors associated with thrombocytopenia in pediatric patients undergoing CRRT.
Main Methods:
- Secondary analysis of the WE-ROCK database included 805 pediatric patients (birth-25 years) undergoing CRRT.
- Exposures: pre-CRRT thrombocytopenia (≤100 × 103/μL) and ≥30% platelet decline at 24h of CRRT.
- Outcomes: ICU discharge survival and 90-day major adverse kidney events (MAKE-90).
Main Results:
- 63.9% of patients had baseline thrombocytopenia, more common in younger, septic patients with higher illness severity.
- A ≥30% platelet decline occurred in 33% of patients, associated with younger age and smaller catheters.
- Univariate analysis showed associations between pre-CRRT thrombocytopenia/platelet decline and ICU mortality, but not in multivariate models or with MAKE-90.
Conclusions:
- Thrombocytopenia is prevalent before CRRT initiation in children and indicates greater illness severity.
- Vigilant monitoring of platelet levels before and during CRRT is essential, as thrombocytopenia may be a prognostic indicator.
- Further research is needed to understand patient and mechanical factors influencing thrombocytopenia during CRRT and to guide interventions.
Introduction:
Thrombocytopenia in patients treated with continuous renal replacement therapy (CRRT) in adults is associated with mortality. Pediatric data are limited. The association between pre-CRRT thrombocytopenia and platelet decline at 24 h of CRRT with outcomes was evaluated.
Methods:
Secondary analysis of the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) includes patients' birth-25 years who underwent CRRT. Exclusions were end-stage kidney disease, non-acute kidney injury/fluid overload CRRT indication, concurrent extracorporeal membrane oxygenation, missing baseline platelets, platelet disorders, and hematologic malignancy. Primary exposures were (i) pre-CRRT thrombocytopenia (≤100 × 103/μL) and (ii) ≥30% decline at 24 h of CRRT in those with pre-CRRT >100 × 103/μL. Primary outcome was survival to intensive care unit (ICU) discharge. Secondary outcomes included major adverse kidney events at 90 days (MAKE-90) (death, dialysis dependence, creatinine >125% baseline) from CRRT initiation.
Results:
A total of 805 patients were included. Overall, 63.9% had baseline thrombocytopenia, median (IQR) platelets of 38 (20, 63) ×103/μL. Baseline thrombocytopenia occurred in younger septic patients with higher illness severity. A ≥30% decline occurred in 33% of patients. Those with a ≥30% platelet decline were more commonly younger patients and had smaller catheters. Pre-CRRT thrombocytopenia and platelet decline were associated with ICU mortality in univariate but not multivariate models. There was no association with MAKE-90.
Conclusions:
Thrombocytopenia is common prior to CRRT initiation and is associated with greater illness severity. These findings stress the importance of vigilant monitoring of platelet levels before CRRT initiation and during therapy as thrombocytopenia at both time points may be a prognostic indicator. Additionally, this study highlights the need for future research to clarify the interplay of patient and mechanical factors in this phenomenon and guide potential interventions.
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