Factors Influencing Duration of Dialysis in Children with Shiga Toxin-Producing <i>Escherichia coli</i>-Associated Hemolytic Uremic Syndrome (STEC-HUS) at a Single Center
October 22, 2020 | 10:00 AM - 12:00 PM
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Factors Influencing Duration of Dialysis in Children with Shiga Toxin-Producing Escherichia coli-Associated Hemolytic Uremic Syndrome (STEC-HUS) at a Single Center
- Pediatric Nephrology: Benign Urology, AKI, Neonatal Nephrology, and Case Reports
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1700 Pediatric Nephrology
- Khalid, Myda, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Pottanat, Neha Dhingra, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Miller, Chloe, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Andreoli, Sharon P., Indiana University School of Medicine, Indianapolis, Indiana, United States
Neha Dhingra Pottanat,
Sharon P. Andreoli,
More than half the children with STEC-HUS require renal replacement therapy. Several factors influence the duration of dialysis.
We performed a retrospective cohort analysis using electronic medical records and chart review of 67 patients with STEC-HUS identified through billing data from July 1st 2008 to August 30th 2015. Cases of atypical hemolytic uremic syndrome (HUS), Streptococcal pneumoniae associated HUS were excluded.
The mean age at presentation with STEC-HUS was 4.9yrs (range 0.99-17.16yrs). 44 (66%) were females compared to 23 (34%) males. Data on intravenous fluids (IVF) administration prior to diagnosis of HUS was available in 54 subjects of which 39 (72%) received IVF anytime during four days prior to presentation, and 15 (28%) did not. Of the patients receiving IVF, 22 (56%) required dialysis for an average duration of 11.4d whereas in subjects without IVF, 7( 47%) required dialysis for an average duration of 14.7d. 9 of 55 subjects received NSAIDS during the illness, and six of the nine required dialysis. For these 6 subjects, the average duration of dialysis was 17d compared to 10.3d in subjects without NSAID exposure. We also evaluated patients for antibiotic exposure before and after the diagnosis of HUS. In 30 (53%) subjects without any antibiotic exposure the average duration on dialysis was 9.8d. For 11 (19 %) subjects receiving antibiotics before the diagnosis of HUS average duration of dialysis was 13.6d. Dialysis duration in the 12 (21%) subjects receiving antibiotics after the diagnosis of HUS was 13.3d.
To our knowledge our study is first to evaluate the impact of NSAIDS on the severity of HUS, and demonstrates that the use of NSAIDS in STEC-HUS increases the duration of dialysis significantly. Confirming previous literature, the use of antibiotics results in prolongation of dialysis regardless of the timing of administration. We also note that IVF administration in the first 4 days prior to the diagnosis of HUS may result in a shorter time on dialysis.