Complications and outcomes of children under one year treated with continuous kidney replacement therapy

Continuous kidney replacement therapy (CKRT) in children under 12 months of age is challenging. This study aimed to compare complications and mortality between patients younger and older than 12 months receiving CKRT and to identify independent mortality risk factors.

Retrospective observational study of pediatric patients treated with CKRT using adult devices in a tertiary hospital (2010-2023). Demographic, clinical, laboratory data, and complications were analyzed. Independent predictors of mortality were identified using multivariate logistic regression.

A total of 186 patients were analyzed; 69% had heart disease. Common complications were catheter replacement (29%), hypotension during connection (28%), bleeding (27%), and hypocalcemia (27%). Overall mortality was 31%. Compared with older children (n = 105), infants under 12 months (n = 81) had greater illness severity, more frequently required ECMO support (57% vs. 25%, p < 0.001) and higher rates of catheter replacement (37% vs. 23%, p = 0.02), hypomagnesemia (23% vs. 10%, p = 0.008), and hypothermia (32% vs. 15%, p = 0.005), but less hypocalcemia (19% vs. 33%, p = 0.017). Mortality was higher among infants (41% vs. 23%, p = 0.007). In multivariate analysis, bleeding (OR 3.16, 95% CI 1.49-6.75, p = 0.003), initial lactate > 3 mmol/L (OR 2.99, 95% CI 1.32-6.87, p = 0.009), and normal initial creatinine (OR 3.20, 95% CI 1.35-7.78, p = 0.009) were independently associated with mortality.

Children under 12 months compared to older children had greater illness severity, more ECMO support, and higher rates of catheter replacement, hypomagnesemia, hypothermia, and mortality, but less hypocalcemia. Independent mortality predictors were bleeding, initial lactate > 3 mmol/L, and normal initial creatinine levels.