Factors associated with successful liberation from continuous renal replacement therapy in children and young adults: analysis of the worldwide exploration of renal replacement outcomes collaborative in Kidney Disease Registry

期刊论文
发表日期：

2024年3月4日

查看全文

Erin K. Stenson,
Issa Alhamoud,
Rashid Alobaidi,
Gabriella Bottari,
Sarah Fernandez,
Dana Y. Fuhrman,
Francesco Guzzi,
Taiki Haga,
Ahmad Kaddourah,
Eleonora Marinari,
Tahagod Mohamed,
Catherine Morgan,
Theresa Mottes,
Tara Neumayr,
Nicholas J. Ollberding,
Valeria Raggi,
Zaccaria Ricci,
Emily See,
Natalja L. Stanski,
Huaiyu Zang,
Emily Zangla,
Katja M. Gist,
Andrea Cappoli,
Eileen A Ciccia,
Michaela Collins,
Denise Colosimo,
Gerard Cortina,
Mihaela A Damian,
Sara De la Mata Navazo,
Gabrielle DeAbreu,
Akash Deep,
Kathy L Ding,
Kristin J Dolan,
Sarah N Lafever Fernandez,
Dana Y Fuhrman,
Ben Gelbart,
Katja M Gist,
Stephen M Gorga,
Francesco Guzzi,
Isabella Guzzo,
Elizabeth Harvey,
Denise C Hasson,
Taylor Hill-Horowitz,
Haleigh Inthavong,
Catherine Joseph,
Ahmad Kaddourah,
Aadil Kakajiwala,
Aaron D Kessel,
Sarah Korn,
Kelli A Krallman,
David M Kwiatkowski,
Jasmine Lee,
Laurance Lequier,
Tina Madani Kia,
Kenneth E Mah,
Eleonora Marinari,
Susan D Martin,
Shina Menon,
Tahagod H Mohamed,
Catherine Morgan,
Theresa A Mottes,
Melissa A Muff-Luett,
Siva Namachivayam,
Tara M Neumayr,
Jennifer Nhan,
Abigail O’Rourke,
Nicholas J Ollberding,
Matthew G Pinto,
Dua Qutob,
Valeria Raggi,
Stephanie Reynaud,
Zaccaria Ricci,
Zachary A Rumlow,
María J Lozano Santiago,
Emily See,
David T Selewski,
Carmela Serpe,
Alyssa Serratore,
Ananya Shah,
Weiwen V Shih,
H Shin Stella,
Cara L Slagle,
Sonia Solomon,
Danielle E Soranno,
Rachana Srivastava,
Natalja L Stanski,
Michelle C Starr,
Erin K Stenson,
Amy E Strong,
Susan A Taylor,
Sameer V Thadani,
Amanda M Uber,
Brynna Wyk,
Tennille N Webb,
Huaiyu Zang,
Emily E Zangla,
Michael Zappitelli

摘要

Purpose

Continuous renal replacement therapy (CRRT) is used for supportive management of acute kidney injury (AKI) and disorders of fluid balance (FB). Little is known about the predictors of successful liberation in children and young adults. We aimed to identify the factors associated with successful CRRT liberation.

Methods

The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease study is an international multicenter retrospective study (32 centers, 7 nations) conducted from 2015 to 2021 in children and young adults (aged 0–25 years) treated with CRRT for AKI or FB disorders. Patients with previous dialysis dependence, tandem extracorporeal membrane oxygenation use, died within the first 72 h of CRRT initiation, and those who never had liberation attempted were excluded. Patients were categorized based on first liberation attempt: reinstituted (resumption of any dialysis within 72 h) vs. success (no receipt of dialysis for ≥ 72 h). Multivariable logistic regression was used to identify factors associated with successful CRRT liberation.

Results

A total of 622 patients were included: 287 (46%) had CRRT reinstituted and 335 (54%) were successfully liberated. After adjusting for sepsis at admission and illness severity parameters, several factors were associated with successful liberation, including higher VIS (vasoactive–inotropic score) at CRRT initiation (odds ratio [OR] 1.35 [1.12–1.63]), higher PELOD-2 (pediatric logistic organ dysfunction-2) score at CRRT initiation (OR 1.71 [1.24–2.35]), higher urine output prior to CRRT initiation (OR 1.15 [1.001–1.32]), and shorter CRRT duration (OR 0.19 [0.12–0.28]).

Conclusions

Inability to liberate from CRRT was common in this multinational retrospective study. Modifiable and non-modifiable factors were associated with successful liberation. These results may inform the design of future clinical trials to optimize likelihood of CRRT liberation success.