Characteristics and outcomes of children ≤ 10 kg receiving continuous kidney replacement therapy: a WE-ROCK study

期刊论文
发表日期：

2024年8月20日

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Shina Menon,
Michelle C. Starr,
Huaiyu Zang,
Michaela Collins,
Mihaela A. Damian,
Dana Fuhrman,
Kelli Krallman,
Danielle E. Soranno,
Tennille N. Webb,
Cara Slagle,
Catherine Joseph,
Susan D. Martin,
Tahagod Mohamed,
Morgan E. Beebe,
Zaccaria Ricci,
Nicholas Ollberding,
David Selewski,
Katja M. Gist,
Emily Ahern,
Ayse Akcan Arikan,
Issa Alhamoud,
Rashid Alobaidi,
Pilar Anton-Martin,
Shanthi S. Balani,
Matthew Barhight,
Abby Basalely,
Amee M. Bigelow,
Gabriella Bottari,
Andrea Cappoli,
Eileen A. Ciccia,
Denise Colosimo,
Gerard Cortina,
Sara De la Mata Navazo,
Gabrielle DeAbreu,
Akash Deep,
Kathy L. Ding,
Kristin J. Dolan,
Sarah NFernandez Lafever,
Ben Gelbart,
Stephen M. Gorga,
Francesco Guzzi,
Isabella Guzzo,
Taiki Haga,
Elizabeth Harvey,
Denise C. Hasson,
Taylor Hill-Horowitz,
Haleigh Inthavong,
Ahmad Kaddourah,
Aadil Kakajiwala,
Aaron D. Kessel,
Sarah Korn,
David M. Kwiatkowski,
Jasmine Lee,
Laurance Lequier,
Tina Madani Kia,
Kenneth E. Mah,
Eleonora Marinari,
Catherine Morgan,
Theresa A. Mottes,
Melissa A. Muff-Luett,
Siva Namachivayam,
Tara M. Neumayr,
Jennifer Nhan,
Abigail O’Rourke,
Matthew G. Pinto,
Dua Qutob,
Valeria Raggi,
Stephanie Reynaud,
Zachary A. Rumlow,
María JSantiago Lozano,
Emily See,
Carmela Serpe,
Alyssa Serratore,
Ananya Shah,
Weiwen V. Shih,
HStella Shin,
Sonia Solomon,
Rachana Srivastava,
Natalja L. Stanski,
Erin K. Stenson,
Amy E. Strong,
Susan A. Taylor,
Sameer V. Thadani,
Amanda M. Uber,
Brynna Van Wyk,
Emily E. Zangla,
Michael Zappitelli,
T. Christine E. Alvarez,
Elizabeth Bixler,
Erica Blender Brown,
Cheryl L. Brown,
Ambra Burrell,
Anwesh Dash,
Jennifer L. Ehrlich,
Simrandeep Farma,
Kim Gahring,
Barbara Gales,
Madison R. Hilgenkamp,
Sonal Jain,
Kate Kanwar,
Jennifer Lusk,
Christopher J. Meyer,
Katherine Plomaritas,
Joshua Porter,
Jessica Potts,
Alyssa Serratore,
Elizabeth Schneider,
Vidushi Sinha,
P. J. Strack,
Sue Taylor,
Katherine Twombley,
Brynna Van Wyk,
Samantha Wallace,
Janet Wang,
Megan Woods,
Marcia Zinger,
Alison Zong

摘要

Background

Continuous kidney replacement therapy (CKRT) is often used for acute kidney injury (AKI) or fluid overload (FO) in children ≤ 10 kg. Intensive care unit (ICU) mortality in children ≤ 10 kg reported by the prospective pediatric CRRT (ppCRRT, 2001–2003) registry was 57%. We aimed to evaluate characteristics associated with ICU mortality using a contemporary registry.

Methods

The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) registry is a retrospective, multinational, observational study of children and young adults aged 0–25 years receiving CKRT (2015–2021) for AKI or FO. This analysis included patients ≤ 10 kg at hospital admission. Primary and secondary outcomes: ICU mortality and major adverse kidney events at 90 days (MAKE-90) defined as death, persistent kidney dysfunction, or dialysis within 90 days, respectively.

Results

A total of 210 patients were included (median age 0.53 years (IQR, 0.1, 0.9)). ICU mortality was 46.5%. MAKE-90 occurred in 150/207 (72%). CKRT was initiated at a median 3 days (IQR 1, 9) after ICU admission and lasted a median 6 days (IQR 3, 16). On multivariable analysis, pediatric logistic organ dysfunction score (PELOD-2) at CKRT initiation was associated with increased odds of ICU mortality (aOR 2.64, 95% CI 1.68–4.16), and increased odds of MAKE-90 (aOR 2.2, 95% CI 1.31–3.69). Absence of comorbidity was associated with lower MAKE-90 (aOR 0.29, 95%CI 0.13–0.65).

Conclusions

We report on a contemporary cohort of children ≤ 10 kg treated with CKRT for acute kidney injury and/or fluid overload. ICU mortality is decreased compared to ppCRRT. The extended risk of death and morbidity at 90 days highlights the importance of close follow-up.

Graphical abstract