Eighteen years experience in pediatric acute dialysis: analysis of predictors of outcome

Abstract

This study reviewed the 18-year experience of acute dialysis in the pediatric intensive care unit, in order to identify factors that could predict outcome, and to determine whether newer modalities of acute dialysis have influenced this outcome. Sixty-six children (ages 1 day to 19 years) received acute dialysis from May 1980 to April 1998. Factors predicting outcome were analyzed using univariate and Cox regression analysis. Modality of dialysis in the first 15 years was exclusively peritoneal dialysis. with a mortality of 63.9%. However, in the last 3 years, with increasing patient numbers, continuous hemodiafiltration (CHDF) was the modality of choice (56.7%), with a mortality of 73.3%. Univariate analysis showed that age <1 year, coma, acute tubular necrosis, disseminated intravascular coagulopathy, assisted ventilation, and hypotension were associated significantly with poor outcome (P<0.05). Cox regression analysis revealed that mortality was significantly higher in patients on mechanical ventilation (RR 5.96, 95% CI 1.82-19.50), or with age <1 year (RR 2.00, 95% CI 1.08-3.73). In conclusion, despite the increasing use of CHDF over the last 3 years, there was no significant improvement in mortality, probably related to the fact that more critically ill patients were dialyzed.

Etiology and outcome of acute kidney injury in children

“…Several risk factors, not always consistently, had been defined for mortality in previous series: younger age [3,26], older age [21], extrarenal diseases [3,22,[26][27][28][29][30][31][32][33], sepsis, septic shock, multiorgan failure [3,26,29,31,[34][35][36][37][38][39], oligoanuria and/or anuria [22,29,40,41], hypotension [32,34,37], use of pressor drugs [33], need for MV [22,26,32,35,36,40], need for dialysis [22,32,35,39,40], and fluid overload [19,42,43]. A common major weaknesses to all of these studies were the relatively small size of the patient groups, the lack of a uniform definition of AKI, staging, and standardized treatment.…”

Two decades’ experience of renal replacement therapy in paediatric patients with acute renal failure

“…As in the present study, Gong et al reported CVVHDF as the primary initial treatment modality in paediatric patients with ARF [6].…”

“…These observations suggest less severe diseases in the second decade. The need for vasopressors is associated with a high mortality [2], as well as low MAP [6,18,19] and ventilatory support [6]. In contrast, all infants younger than one year had low MAP and all needed ventilatory and vasopressor support in the second decade [2,6,18,19].…”

“…The haemolytic uraemic syndrome which has been reported to have high incidences with up to 45% of all causes for ARF [10,14,16] remained nearly constant during both decades. The mortality rates of patients who underwent RRT were extremely variable, ranging from 25% to 73% [5,6,8,10,14,16]. The reasons for this are different patient groups with different age distributions, underlying diseases and modalities of RRT.…”

“…Some more recent epidemiological studies described the experiences of ARF [15] and acute dialysis [6] in paediatric patients up to 1998. These data do not include advances in the therapy of underlying diseases and modality of RRT during the last decade.…”