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Clinical Profile and Survival Outcomes of Children with Acute Kidney Injury Requiring Renal Replacement Therapy: A
Swarnim Swarnim1, Arnab Ghorui1, Sneh Kumar1
1Department of Paediatrics, All India Institute of Medical Sciences, Patna, Bihar, India.
Insights
Pediatric acute kidney injury (AKI) requiring renal replacement therapy (RRT) has high mortality, often due to sepsis and fluid overload. Peritoneal dialysis (PD) showed higher mortality risk than hemodialysis (HD), likely due to patient selection.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Acute kidney injury (AKI) in children, especially critically ill ones, carries a high mortality rate despite advances in renal replacement therapy (RRT).
- Understanding the causes and outcomes of RRT in pediatric AKI is crucial for improving patient care.
Purpose of the Study:
- To investigate the causes and indications for RRT in pediatric AKI.
- To identify factors predicting mortality in these patients.
- To compare survival rates between hemodialysis (HD) and peritoneal dialysis (PD).
Main Methods:
- A retrospective observational study of 40 children (1 month-18 years) receiving RRT for AKI at a tertiary care center in India.
- Data included demographics, clinical status, and laboratory results, with AKI defined by KDIGO 2012 criteria.
- Statistical analyses included logistic regression and Cox proportional hazards models to assess mortality predictors and compare survival between HD and PD.
Main Results:
- Sepsis was the leading cause of AKI (39.5%), and refractory fluid overload was the primary indication for RRT (67.5%).
- Non-survivors had higher rates of sepsis, multiple organ dysfunction syndrome (MODS), comorbidities, and fluid overload.
- While univariate analysis showed associations, multivariate analysis did not identify independent mortality predictors. The PD group had a higher in-hospital mortality risk (HR=4.41, p=0.026).
Conclusions:
- Sepsis, MODS, and significant fluid overload are associated with higher mortality in pediatric AKI patients requiring RRT.
- The observed higher mortality in the PD group may be attributed to selection bias, with PD used in sicker patients.
Background And Aims:
Acute kidney injury (AKI) in children is a serious and potentially life-threatening condition, particularly among critically ill patients. Despite advances in renal replacement therapy (RRT), mortality remains high. This study aimed to evaluate the etiology and indications for RRT in pediatric AKI, identify predictors of mortality, and compare survival outcomes between hemodialysis (HD) and peritoneal dialysis (PD).
Patients And Methods:
This single-center, retrospective observational study included children aged 1 month to 18 years who received RRT for AKI at a tertiary care hospital in Eastern India between January 2023 and December 2024. Acute kidney injury was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 criteria. Demographic, clinical (including illness severity scores), and laboratory data were extracted from medical records. Predictors of mortality were evaluated using univariate and multivariate logistic regression analysis. Kaplan-Meier estimation, the log-rank test, and Cox proportional hazards regression analysis were used to compare survival between HD and PD.
Results:
Out of 40 patients, 28 (70%) received HD and 12 (30%) underwent PD. The overall in-hospital mortality rate was 27.5% (11/40). The most common cause of AKI necessitating RRT was sepsis (39.5%), which included urosepsis and systemic sepsis. Refractory fluid overload (>10%) was the primary indication for RRT initiation in 67.5% of patients. Non-survivors had a significantly higher prevalence of sepsis, multiple organ dysfunction syndrome (MODS), underlying comorbidities, vasopressor use, and greater mean percentage of fluid overload (mean: 16.8% in non-survivors vs 8.3% in survivors; p = 0.003). In univariate analysis, dialysis modality, comorbidities, fluid overload, sepsis, MODS, and vasopressor use were significantly associated with mortality. However, none of these were independently predictive in the multivariate logistic regression analysis. Median time to in-hospital death or discharge was significantly longer in the HD group (88 vs 22 days, p = 0.0012). Cox regression showed an increased association with in-hospital mortality risk in the PD group [hazard ratio (HR) = 4.41, 95% confidence interval (CI): 1.19-16.33, p = 0.026].
Conclusion:
Higher mortality was observed in patients with sepsis, MODS, and significant fluid overload. The higher mortality in the PD group is likely attributable to selection bias, as PD was preferentially used in sicker, hemodynamically unstable patients.
How To Cite This Article:
Swarnim S, Ghorui A, Kumar S, Prasad A. Clinical Profile and Survival Outcomes of Children with Acute Kidney Injury Requiring Renal Replacement Therapy: A Retrospective Study from a Tertiary Pediatric Intensive Care Unit. Indian J Crit Care Med 2026;30(3):211-217.
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