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Urine Output Trajectories and Dialysis Independence in Critically Ill Children With Acute Kidney Injury: A
Yusuke Tokuda1, Kentaro Ide1, Junichiro Morota1
1Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan.
Insights
Urine output trajectory predicts dialysis independence in critically ill children with acute kidney injury (AKI) receiving continuous kidney replacement therapy (CKRT). Higher urine output on day 14 of CKRT may indicate future dialysis independence.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Acute kidney injury (AKI) is a significant concern in critically ill children.
- Continuous kidney replacement therapy (CKRT) is a vital treatment for pediatric AKI.
- Predicting dialysis independence post-CKRT is crucial for patient management.
Purpose of the Study:
- To determine if urine output patterns predict dialysis independence in pediatric AKI patients on CKRT.
- To assess the association between urine output trajectory and long-term dialysis dependence.
Main Methods:
- Retrospective cohort study of 61 critically ill children (under 16) with AKI receiving CKRT in a Japanese PICU (2014-2023).
- Analysis of urine output at multiple time points (days 3, 7, 14, 21) post-CKRT initiation.
- Evaluation of the predictive value of urine output for dialysis independence at 30 days.
Main Results:
- Dialysis dependence was linked to significantly lower urine output on days 3, 7, 14, and 21 post-CKRT.
- Higher urine output on day 14 (≥0.41 mL/kg/hr) strongly predicted dialysis independence at 30 days (AUROC 0.96).
- A urine output of ≥0.41 mL/kg/hr on day 14 increased the probability of dialysis independence to 97%.
Conclusions:
- Urine output on day 14 of CKRT is a strong predictor of 30-day dialysis independence in critically ill children with AKI.
- A urine output threshold of ≥0.41 mL/kg/hr on day 14 may serve as an effective diagnostic marker.
- Further validation studies are recommended to confirm these findings.
Objectives:
To investigate whether the urine output trajectory is associated with dialysis independence in critically ill children with acute kidney injury (AKI).
Design:
Retrospective cohort study.
Setting:
A PICU in Japan.
Patients:
Children younger than 16 years old who received continuous kidney replacement therapy (CKRT) for AKI between July 1, 2014, and June 30, 2023.
Interventions:
None.
Measurements And Main Results:
We identified 61 eligible patients, including 16 patients who remained dialysis-dependent 30 days after CKRT initiation. Compared with dialysis-independent patients, dialysis dependence was associated with lower urine output on days 3, 7, 14, and 21 after CKRT initiation. Dialysis independence, when compared with dialysis dependence, was associated with higher median (interquartile range) urine output (mL/kg/hr) at each timepoint (day 3: 0.3 [0.1-1.6] vs. 0.0 [0-0.2]; p = 0.001; day 7: 1.3 [0.4-2.0] vs. 0.0 [0-0.1]; p < 0.001; day 14: 1.8 [1.0-3.5] vs. 0.0 [0-0; p < 0.001]; and day 21: 2.1 [1.1-3.0] vs. 0.0 [0-0]; p < 0.001). The area under the receiver operating characteristic curve (AUROC with 95% CI) for identifying dialysis independence at day 30 after CKRT initiation, based on urine output on day 14, was 0.96 (95% CI, 0.88-1.00). Using the DeLong test, this AUROC was higher than that on day 7 (0.88 [95% CI, 0.77-0.99]; p = 0.009). Also, on day 14, with a pre-test probability of dialysis independence of 71%, the post-test probability increases to 97% when using a test urine output greater than or equal to 0.41 mL/kg/hr. The sensitivity analysis with the exclusion of neonates yielded similar results.
Conclusions:
In this 2014-2023 cohort of critically ill children with AKI supported with CKRT, using a urine output greater than or equal to 0.41 mL/kg/hr on day 14, CKRT may be an effective diagnostic test of dialysis independence on day 30. Further validation studies are needed.
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