Related Experiment Video
Updated: Sep 10, 2025
5/6 Nephrectomy Using Sharp Bipolectomy Via Midline Laparotomy in Rats
Published on: April 4, 2025
Predicting mortality and short-term outcomes of continuous kidney replacement therapies in neonates and infants
Anna Deja1,2, Kamil Deja3,4, Andrea Cappoli5
1Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland.
Insights
Artificial intelligence models identified key factors for mortality and kidney issues in infants and neonates undergoing continuous kidney replacement therapy (CKRT). Lower urine output and longer time to CKRT initiation increased mortality risk.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Artificial Intelligence in Healthcare
Background:
- Continuous kidney replacement therapy (CKRT) is crucial for critically ill neonates and infants with acute kidney injury (AKI).
- Identifying factors influencing mortality and adverse kidney outcomes in this vulnerable population is essential.
Purpose of the Study:
- To apply Artificial Intelligence (AI), specifically XGBoost models, to identify clinical factors associated with short-term outcomes in neonates and infants undergoing CKRT.
- To predict mortality and proteinuria at hospital discharge in this patient group.
Main Methods:
- Utilized data from the EurAKId registry (NCT02960867) including neonates and infants treated with CKRT.
- Employed AI XGBoost models to analyze clinical characteristics, anthropometric features, and CKRT technical settings.
- Identified key predictors for mortality and proteinuria at discharge.
Main Results:
- The study included 95 patients; overall mortality was 47.3%.
- AI models indicated lower urine output, greater serum creatinine rise, delayed CKRT initiation, and lower blood pressure as mortality risk factors.
- Higher admission/CKRT start serum creatinine and primary kidney disease predicted proteinuria at discharge.
Conclusions:
- XGBoost models effectively identify short-term outcome predictors in pediatric CKRT patients.
- Early indicators of AKI severity and treatment delay are critical for mortality risk in neonates and infants.
- Primary kidney disease and biochemical markers are significant predictors of proteinuria.
Background:
Continuous kidney replacement therapy (CKRT) has emerged as a valuable treatment option in critically ill neonates and infants with acute kidney injury (AKI) requiring dialysis. In this population, we apply artificial intelligence (AI) to identify factors influencing mortality and short-term adverse kidney outcomes.
Methods:
The study involved neonates and infants included in the EurAKId Registry (NCT02960867), who underwent CKRT treatment. Using the AI XGBoost models, we identified key clinical factors associated with short-term outcomes: mortality before hospital discharge, as well as proteinuria at discharge. We considered the patients' clinical characteristics, anthropometric features, and CKRT technical settings.
Results:
The study comprised 95 patients: 31.6% neonates and 68.4% infants with a median age at hospital admission of 1 month (interquartile range, IQR 0-7 months). Ten children were born prematurely. The overall mortality rate was 47.3% and did not differ significantly between neonates and infants (53.3% vs 44.4%, respectively, P = .422). The XGBoost model for predicting mortality had the accuracy of 59.53% ± 0.96% and AUC of 0.64 ± 0.11. Lower urine output at CKRT initiation, a greater rise in serum creatinine (SCr), longer time to dialysis initiation, and lower blood pressure were associated with increased risk of mortality. Proteinuria at hospital discharge was present in 30.6% of survivors. The XGBoost model for predicting proteinuria had the accuracy of 79.11% ± 2.46% and AUC (0.74 ± 0.04). Higher SCr concentrations at hospital admission and at CKRT start, as well as primary kidney disease were the most important risk factors for proteinuria.
Conclusion:
We propose the XGBoost models for identifying factors associated with short-term outcomes of CKRT in neonates and infants. Lower urine output at CKRT start, more severe AKI progression and longer time to CKRT initiation might be important risk factors for mortality in infants and neonates. Primary kidney disease and related biochemical parameters are strong predictors of proteinuria at hospital discharge.
Related Concept Videos
01:30Continuous Renal Replacement Therapy
01:16Kidney Transplant III: Nursing Management
01:28Kidney Transplant I: Introduction
01:20Acute Kidney Injury V: Interprofessional Care
01:29Acute Kidney Injury III: Clinical Manifestations
01:26Kidney Transplant II: Surgical Procedure