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Functional outcomes in pediatric patients on renal replacement therapy in a worldwide registry
Kristin J Dolan1, Katja M Gist2, Abby Basalely3
1Baylor College of Medicine, Texas Children's Hospital, Department of Pediatrics, Houston, TX, USA.
Insights
Children on continuous renal replacement therapy (CRRT) often experience worse functional status and new morbidities post-discharge. Multidisciplinary follow-up is crucial for optimizing outcomes in these vulnerable pediatric patients.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Clinical Outcomes Research
Background:
- Continuous renal replacement therapy (CRRT) improves survival in critically ill children but is associated with significant morbidity.
- Functional outcomes in pediatric patients undergoing CRRT require further investigation to guide post-treatment care.
- The Functional Status Scale (FSS) is a tool to assess functional outcomes in this population.
Purpose of the Study:
- To evaluate the functional outcomes of children receiving CRRT using the Functional Status Scale (FSS).
- To determine the incidence of new morbidities at hospital discharge and during follow-up.
- To identify predictors of functional status and the impact of renal recovery on outcomes.
Main Methods:
- Retrospective chart review of pediatric patients (birth to 25 years) on CRRT from the WE-ROCK international multi-center registry.
- Exclusion of patients with underlying kidney disease, on ECMO, and non-survivors.
- Collection of FSS data at hospital discharge, 6 months, and 12 months post-discharge.
Main Results:
- At discharge, 527 patients had a median FSS of 7, with 39% experiencing worse functional status and 18% acquiring new morbidity.
- Predictors of FSS at discharge included baseline FSS, weight, comorbidities, mechanical ventilation, and sepsis.
- At 6 months, 387 patients had a median FSS of 6, with 10% acquiring new morbidity. Discharge FSS and comorbidities predicted 6-month FSS.
Conclusions:
- This is the first large, multi-center study assessing functional outcomes in children on CRRT.
- Persistent morbidity post-discharge highlights the need for comprehensive assessment and multidisciplinary follow-up.
- Optimizing long-term functional status in pediatric CRRT survivors requires targeted interventions and ongoing care.
Background And Hypothesis:
Mortality rates of children supported with continuous renal replacement therapy (CRRT) have improved, yet morbidity remains high. We aimed to evaluate the functional outcomes of children receiving CRRT using Functional Status Scale (FSS). We hypothesized that children receiving CRRT will have worse FSS compared with their baseline and acquire new morbidity at hospital discharge and 6 and 12 months post-discharge, and that lack of renal recovery will contribute to worsening functional status.
Methods:
This is a retrospective chart review from The Worldwide Exploration of Renal Replacement Outcomes Collaborate in Kidney Disease (WE-ROCK), an international multi-center registry. Twenty-eight centers across five countries participated in this analysis. Children from birth to 25 years, on CRRT for acute kidney injury (AKI) or fluid overload, were included. Patients with underlying kidney disease, on extracorporeal membrane oxygenation and non-survivors were excluded. FSS was collected at discharge (n = 527), 6 months (n = 387) and 12 months post-discharge (n = 344). The primary outcome was FSS at discharge and 6 months. Secondary outcomes included: new morbidity at discharge and 6 months; FSS at 12 months; and the impact of renal recovery on functional outcomes.
Results:
A total of 527 patients had median FSS of 7 (6, 90) at hospital discharge. Thirty-nine percent (n = 204) had worse FSS. Eighteen percent (95/527) acquired a new morbidity at discharge. Predictors of FSS at discharge were baseline FSS {odds ratio (OR) 1.30 [95% confidence interval (CI) 1.11-1.52]}, weight [OR 0.99 (95% CI 0.98-0.9997)], comorbidities [OR 1.88 (95% CI 1.16-3.04)], mechanical ventilation [OR 1.72 (95% CI 1.04-2.85)] and sepsis on intensive care unit admission [OR 1.46 (95% CI 1.01-2.21)]. A total of 387 patients had median FSS score of 6 (6, 8) at 6 months. Ten percent (n = 39/387) acquired new morbidity at 6 months. The significant predictors of FSS at 6 months were FSS at discharge [OR 2.36 (95% CI 1.95-2.84)] and presence of comorbidities [OR 1.77 (95% CI 1.03-3.06)].
Conclusion:
This is the first large, multi-center study evaluating functional outcomes of children on CRRT. Persistent morbidity following discharge emphasizes the importance of comprehensive identification and multidisciplinary follow-up to optimize patient outcomes.
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