Kidney Week

Abstract: TH-PO1202

Mortality Predictors in Critically Ill Children Receiving CRRT: An Eight-Year Cohort Study

Session Information

• Pediatric Nephrology: CV Health, CKD, AKI, Dialysis, Transplantation, and Health Services Research
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1800 Pediatric Nephrology

Authors

• Vieira, Simone, Hospital Samaritano de Sao Paulo, São Paulo, SP, Brazil

Simone Vieira, MS, MSc

• Carvalho, Maria Fernanda Camargo, Hospital Samaritano de Sao Paulo, São Paulo, SP, Brazil

Maria Fernanda Camargo Carvalho, MD

• Pacheco, Pollyanna Santos, Hospital Samaritano de Sao Paulo, São Paulo, SP, Brazil

Pollyanna Santos Pacheco

• Hatanaka, Eduardo Freitas, Hospital Samaritano de Sao Paulo, São Paulo, SP, Brazil

Eduardo Freitas Hatanaka, MD

• Henriques, Cristina Lucia, Hospital Samaritano de Sao Paulo, São Paulo, SP, Brazil

Cristina Lucia Henriques, MD

• Koch Nogueira, Paulo C., Hospital Samaritano de Sao Paulo, São Paulo, SP, Brazil

Paulo C. Koch Nogueira, MD

Background

Acute kidney injury (AKI) in critically ill children is associated with high morbidity and mortality, particularly in patients requiring continuous renal replacement therapy (CRRT). Despite advances in pediatric intensive care and dialysis support, mortality rates remain elevated, and the identification of independent predictors of poor outcomes is essential to optimize timing of intervention and clinical management strategies.
The objective was to identify independent predictors of mortality in critically ill pediatric patients with KDIGO stage 3 acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) in an 8-year cohort study.

Methods

Retrospective analysis of data from patients with acute kidney injury with indication for CRRT. The outcome of the study was death (yes/no), and the predictive factors of death considered were: gender, age, underlying etiology, causes of ICU admission, fluid overload, use of diuretics, use of vasoactive drugs, and length of stay in the ICU before dialysis initiation.

Results

A total of 142 patients were included, of whom 105 (74%) were male; 59 (41%) had kidney disease, 55 (39%) had cancer, and 18 (12%) had heart disease. The median age was 5 years (interquartile range 1.5–10.0 years). Sepsis was the main indication for ICU admission in 46 patients (32%), followed by respiratory failure in 34 (24%). Hypervolemia was the main indication for CRRT initiation in 114 patients (80%). Death occurred in 61 children (43%). In the multivariate analysis, the factors significantly associated with mortality were: (1) underlying disease, with oncologic and renal disease associated with lower mortality risk compared with cardiac disease (OR = 0.44, 95% CI 0.0–0.33 and OR = 0.05, 95% CI 0.01–0.30; p < 0.01, respectively); (2) use of vasoactive drugs (OR = 17.8, 95% CI 4.03–78.6; p < 0.01); and (3) longer ICU stay before CRRT initiation (OR = 1.11, 95% CI 1.02–1.21; p < 0.001).

Conclusion

AKI requiring CRRT in critically ill children remains associated with high mortality. In this cohort, cardiac disease, vasoactive drug requirement, and delayed initiation of CRRT were independent predictors of poor outcomes. Each additional day between ICU admission and CRRT initiation increased the risk of death by 11%, reinforcing the importance of early recognition and timely initiation of renal support therapy in pediatric critical care.