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Characteristics and outcomes of children ≤ 10 kg receiving continuous kidney replacement therapy: a WE-ROCK study
Journal article   Peer reviewed

Characteristics and outcomes of children ≤ 10 kg receiving continuous kidney replacement therapy: a WE-ROCK study

Shina Menon, Michelle C Starr, Huaiyu Zang, Michaela Collins, Mihaela A Damian, Dana Fuhrman, Kelli Krallman, Danielle E Soranno, Tennille N Webb, Cara Slagle, …
Pediatric nephrology (Berlin, West), Vol.40(1), pp.253-264
01/2025
DOI: 10.1007/s00467-024-06438-x
PMCID: PMC11969683
PMID: 39164502
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC11969683/pdf/nihms-2061481.pdfView
Open Access

Abstract

Continuous kidney replacement therapy (CKRT) is often used for acute kidney injury (AKI) or fluid overload (FO) in children ≤ 10 kg. Intensive care unit (ICU) mortality in children ≤ 10 kg reported by the prospective pediatric CRRT (ppCRRT, 2001-2003) registry was 57%. We aimed to evaluate characteristics associated with ICU mortality using a contemporary registry. The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) registry is a retrospective, multinational, observational study of children and young adults aged 0-25 years receiving CKRT (2015-2021) for AKI or FO. This analysis included patients ≤ 10 kg at hospital admission. ICU mortality and major adverse kidney events at 90 days (MAKE-90) defined as death, persistent kidney dysfunction, or dialysis within 90 days, respectively. A total of 210 patients were included (median age 0.53 years (IQR, 0.1, 0.9)). ICU mortality was 46.5%. MAKE-90 occurred in 150/207 (72%). CKRT was initiated at a median 3 days (IQR 1, 9) after ICU admission and lasted a median 6 days (IQR 3, 16). On multivariable analysis, pediatric logistic organ dysfunction score (PELOD-2) at CKRT initiation was associated with increased odds of ICU mortality (aOR 2.64, 95% CI 1.68-4.16), and increased odds of MAKE-90 (aOR 2.2, 95% CI 1.31-3.69). Absence of comorbidity was associated with lower MAKE-90 (aOR 0.29, 95%CI 0.13-0.65). We report on a contemporary cohort of children ≤ 10 kg treated with CKRT for acute kidney injury and/or fluid overload. ICU mortality is decreased compared to ppCRRT. The extended risk of death and morbidity at 90 days highlights the importance of close follow-up.
 Acute Kidney Injury - epidemiology Acute Kidney Injury - etiology Acute Kidney Injury - mortality Acute Kidney Injury - therapy Adolescent Adult Child Child, Preschool Continuous Renal Replacement Therapy - adverse effects Continuous Renal Replacement Therapy - methods Female Hospital Mortality Humans Infant Infant, Newborn Intensive Care Units - statistics & numerical data Male Registries - statistics & numerical data Retrospective Studies Treatment Outcome Water-Electrolyte Imbalance - epidemiology Water-Electrolyte Imbalance - etiology Water-Electrolyte Imbalance - therapy Young Adult

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