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Major adverse kidney events in children requiring continuous kidney replacement therapy: a single-center
Yusuke Tokuda1, Kentaro Ide1, Junichiro Morota1
1Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan.
Insights
In Japanese children treated with continuous kidney replacement therapy (CKRT), over half experienced major adverse kidney events (MAKE) within 90 days. Longer CKRT duration and lower urine output were linked to these adverse outcomes.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Continuous kidney replacement therapy (CKRT) is vital for pediatric acute kidney injury.
- A significant number of children on CKRT experience major adverse kidney events (MAKE), including death or persistent kidney dysfunction.
- Data on MAKE following pediatric CKRT in Japan are limited.
Purpose of the Study:
- To investigate the incidence of major adverse kidney events (MAKE) at 90 days (MAKE-90) in Japanese children treated with CKRT.
- To identify clinical factors associated with MAKE-90 in this pediatric cohort.
Main Methods:
- A retrospective study of 51 pediatric patients (<16 years) receiving CKRT for renal indications.
- Data collected from July 2014 to June 2023 at a tertiary pediatric center.
- Univariate logistic regression analysis used to assess associations between MAKE-90 and clinical characteristics.
Main Results:
- 55% of patients (28/51) experienced MAKE-90.
- MAKE-90 components included death (27%), dialysis dependence (20%), and persistent kidney dysfunction (8%).
- Longer CKRT duration (OR 1.06) and lower urine output at 14 days post-CKRT initiation (OR 0.33) were significantly associated with MAKE-90.
Conclusions:
- The incidence of MAKE-90 in this Japanese cohort is comparable to international rates.
- Longer CKRT duration and diminished urine output on day 14 may serve as prognostic markers for adverse kidney outcomes in pediatric CKRT patients.
Background:
Continuous kidney replacement therapy (CKRT) is an essential supportive therapy for children with acute kidney injury. Nevertheless, a considerable proportion of patients fail to recover kidney function and present with major adverse kidney events (MAKE), a composite outcome including death, dialysis dependence, or persistent kidney dysfunction. Recent international pediatric collaborative studies, mainly from North America, have reported on MAKE following pediatric CKRT. However, such data from Japan remain limited.
Methods:
We conducted a single-center retrospective study of patients under 16 years of age who received CKRT for renal indications in a tertiary pediatric center between July 2014 and June 2023. The primary outcome was MAKE at 90 days after CKRT initiation (MAKE-90). We used univariate logistic regression analysis to evaluate the association between MAKE-90 and clinical characteristics.
Results:
Of the 51 eligible patients, 28 (55%) experienced MAKE-90. The components of MAKE-90 were death in 14 patients (27%), dialysis dependence in 10 (20%), and persistent kidney dysfunction in 4 (8%). Univariate logistic regression analysis revealed that CKRT duration (days) [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.00-1.12] and urine output (mL/kg/h) at 14 days after CKRT initiation (OR 0.33, 95% CI 0.14-0.80) were significantly associated with MAKE-90.
Conclusion:
The incidence of MAKE-90 in our Japanese cohort was over half of the children requiring CKRT, comparable to rates reported in international multicenter studies. Longer CKRT duration and lower urine output on day 14 were associated with MAKE-90, suggesting that these factors may serve as potential prognostic markers.
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