Outcome of continuous renal replacement therapy in critically ill children: a retrospective cohort study

Abstract

BACKGROUNDContinuous renal replacement therapy (CRRT) has become the preferred mode of dialysis to support critically ill children with acute kidney injury. However, there are limited pediatric data on CRRT use, especially in our region.OBJECTIVEDetermine the outcome of CRRT among critically ill children.DESIGNRetrospective cohort study.SETTINGPediatric intensive care unit.PATIENTS AND METHODSThe study included critically ill children 1–14 years of age who underwent CRRT from July 2009 to June 2015. We report the underlying diagnosis, demographics, indications and modality of CRRT, and associated risk factors. Statistical analyses were used to identify risk factors associated with mortality.MAIN OUTCOME MEASURESMortality and associated risk factors with use of CRRT.SAMPLE SIZE96RESULTSThe mean age was 6.0 (standard deviation, 4.4) years, with a male preponderance in the age group from 1–10 years which comprised almost 60% of the study group. The most common primary diagnoses were malignancies [37.5% (36/96)] followed by primary renal diseases [19.8% (19/96)], and immunodeficiency [16.7% (16/96)]. The most common indication for CRRT was fluid overload [67.2% (65/96)] followed by tumor lysis syndrome [18.8%(18/96)], and metabolic encephalopathy [9.4%(9/96)]. The median length of CRRT was 66 hours (IQR, 35.5–161.4), with a median average circuit life of 30.9 hours (IQR, 16.4–45.0). The most common CRRT catheter site was the internal jugular vein [77.1% (74/96)], followed by the femoral vein [18.8%(18/96)] with continuous venovenous hemodiafiltration [82.3%(79/96)] being the most common CRRT modality used. The mortality rate among critically ill children requiring CRRT was 50% (48/96). There was an increased mortality rate among children with hematological diseases (100%, 10/10), immunodeficiency (86.6%, 13/16) and in children who had undergone stem cell transplantation (90.0%, 27/30), with the least mortality in primary renal disease (15.8% (3/19). We identified septic shock and use of inotropic support as being independently associated with mortality in a multivariate analysis.CONCLUSIONThe overall mortality rate among critically ill children who underwent CRRT was 50% with significantly increased mortality among patients with hematological diseases, immunodeficiency, and in children who had undergone stem cell transplantation. Septic shock and use of inotropic support were associated with mortality.LIMITATIONSRetrospective and single center data that is not generalizable.

Continuous renal replacement therapy in Iran; current practice, indications and outcomes in hemodynamically unstable patients

“…Based on the clinical records, the most common underlying diseases leading to RRT in the current study were diabetes (36.9%) and hypertension (25.8%). These results were consistent with the reports of other studies indicating hypertension and diabetes as the underlying causes of RRT in 36.4% to 62.1% of the cases (11,(32)(33)(34). In some multicenter studies in children, malignancy has been reported as the most common primary diagnosis in patients requiring RRT (11).…”

“…These results were consistent with the reports of other studies indicating hypertension and diabetes as the underlying causes of RRT in 36.4% to 62.1% of the cases (11,(32)(33)(34). In some multicenter studies in children, malignancy has been reported as the most common primary diagnosis in patients requiring RRT (11). Overall, special attention must be dedicated to diabetes and hypertension as the main comorbidities leading to RRT.…”

“…The factors affecting the mortality rate in these patients include the staff 's experience, timing of dialysis initiation, and the presence of comorbidities. Nonetheless, the global rate of in-hospital mortality has been similar to our study (11,34,37).…”

“…In other studies, CVVHD had been used in 48-82% of pediatric patients. Nevertheless, recent studies have indicated a shift toward using CVVHDF as the main CRRT strategy (11,13,32,33), but our CRRT machine does not support this mode of treatment. As the CVVHDF mode of CRRT was not supported by our instrument, neither of our patients underwent this method.…”

“…This approach is increasingly used in intensive care units (ICUs) and cardiovascular care units (CCUs), especially in patients with sepsis (5)(6)(7)(8)(9)(10). In comparison with intermittent hemodialysis (IHD), CRRT delivers a slow-acting removal of the waste materials while retaining the hemodynamic stability and intravascular volume (11,10). In studies investigating the clinical implications of CRRT, better outcomes, as well as higher survival and residual renal function have been reported in long-term follow-up (12)(13)(14)(15)(16).…”