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Kidney Week

Abstract: PO0260

Midterm Renal Outcomes and Renal Recovery in Pediatric Continuous Renal Replacement Therapy

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Thadani, Sameer, Baylor College of Medicine, Houston, Texas, United States
  • Fuhrman, Dana Y., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Hanson, Claire, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Carcillo, Joseph A., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Srivaths, Poyyapakkam, Baylor College of Medicine, Houston, Texas, United States
  • Akcan Arikan, Ayse, Baylor College of Medicine, Houston, Texas, United States
Background

Most pediatric continuous renal replacement therapy(CRRT) outcome studies focus on crude mortality. Recent data highlighted incomplete recovery and dialysis dependency in pediatric acute kidney injury treated with dialysis. We described midterm outcomes and renal recovery in pediatric CRRT.

Methods

Multicenter cohort study between 2/14-2/20. Primary outcome was Major Adverse Kidney Events at 90 days(MAKE90), secondary outcome was renal recovery (noMAKE90 in survivors).

Results

419 patients received CRRT for 9 days (IQR3-21) (age 93 mo (17-180), 51% male).PELOD2 was 9(7-14), 55% were ventilated, 67% were on vasoactives. 276(66%) patients had MAKE90 (61% dead, 21% dialysis dependent,18% persistent renal dysfunction). ICU admission reason, peak mean airway pressure, thrombocytopenia, and leukopenia were associated with MAKE90. Urine output at CRRT start was independently associated with renal recovery, each ml/kg/h was associated with 47%(95%CI 12-235%) increased odds of renal recovery.

Conclusion

Majority of pediatric CRRT patients develop MAKE90. Worse lung disease requiring higher respiratory support is independently associated with MAKE90, while admissions for metabolic/endocrine reasons are more likely to survive with intact renal function. Urine output at CRRT start is an independent predictor of renal recovery among pediatric CRRT survivors.

MAKE90 and Renal Recovery In Survivors
MAKE90    
CovariateUnadjusted OR95% CIAdjusted OR*95% CI
Age1.000.99-1.001.010.99 -1.01
PELOD-20.990.97-1.020.970.82- 1.13
%fluid overload0.990.66-1.490.980.59- 1.61
Thrombocytopenia (<100k)2.09 1.33-3.302.04 0.73-5.74
Leukopenia(<4k) 2.80 1.37-5.72 1.57 0.45- 5.51
Mean airway pressure, cm H20 1.16 1.06-1.27 1.15 1.04- 1.28
ICU admission reason
Metabolic/endocrine
0.22 0.05-0.940.100.02-0.56
ICU admission reason
Renal
5.00 1.45-17.271.37 0.18-10.55
Renal recovery among survivors    
Age 0.99 0.99-1.00 1.00 0.99-1.00
PELOD-2 1.03 0.99-1.06 1.02 0.93-1.12
%fluid overload 0.99 0.62-1.57 0.94 0.57-1.57
Vasoactive infusion 0.57 0.31-1.05 0.52 0.27-1.01
Urine output (ml/kg/h) at CRRT start 1.47 1.05-2.06 1.62 1.12-2.35
Leukopenia at CRRT start 0.43 0.17-1.07 0.47 0.18-1.27
Thrombocytopenia at CRRT start 0.60 0.36-0.99 0.56 0.27-1.14

*All controlled for each other