Factors associated with successful liberation from continuous renal replacement therapy in children and young adults: analysis of the worldwide exploration of renal replacement outcomes collaborative in Kidney Disease Registry

Erin K Stenson; Issa Alhamoud; Rashid Alobaidi; Gabriella Bottari; Sarah Fernandez; Dana Y Fuhrman; Francesco Guzzi; Taiki Haga; Ahmad Kaddourah; Eleonora Marinari; Tahagod Mohamed; Catherine Morgan; Theresa Mottes; Tara Neumayr; Nicholas J Ollberding; Valeria Raggi; Zaccaria Ricci; Emily See; Natalja L Stanski; Huaiyu Zang; Emily Zangla; Katja M Gist; Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Diseases (WE-ROCK) Investigators; Amy E Strong

doi:10.1007/s00134-024-07336-4

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Factors associated with successful liberation from continuous renal replacement therapy in children and young adults: analysis of the worldwide exploration of renal replacement outcomes collaborative in Kidney Disease Registry

Journal article

Open access

Peer reviewed

Factors associated with successful liberation from continuous renal replacement therapy in children and young adults: analysis of the worldwide exploration of renal replacement outcomes collaborative in Kidney Disease Registry

Erin K Stenson, Issa Alhamoud, Rashid Alobaidi, Gabriella Bottari, Sarah Fernandez, Dana Y Fuhrman, Francesco Guzzi, Taiki Haga, Ahmad Kaddourah, Eleonora Marinari, …

Intensive care medicine, Vol.50(6), pp.861-872

06/01/2024

DOI: 10.1007/s00134-024-07336-4

PMCID: PMC11164640

PMID: 38436726

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Abstract

Continuous renal replacement therapy (CRRT) is used for supportive management of acute kidney injury (AKI) and disorders of fluid balance (FB). Little is known about the predictors of successful liberation in children and young adults. We aimed to identify the factors associated with successful CRRT liberation. The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease study is an international multicenter retrospective study (32 centers, 7 nations) conducted from 2015 to 2021 in children and young adults (aged 0-25 years) treated with CRRT for AKI or FB disorders. Patients with previous dialysis dependence, tandem extracorporeal membrane oxygenation use, died within the first 72 h of CRRT initiation, and those who never had liberation attempted were excluded. Patients were categorized based on first liberation attempt: reinstituted (resumption of any dialysis within 72 h) vs. success (no receipt of dialysis for ≥ 72 h). Multivariable logistic regression was used to identify factors associated with successful CRRT liberation. A total of 622 patients were included: 287 (46%) had CRRT reinstituted and 335 (54%) were successfully liberated. After adjusting for sepsis at admission and illness severity parameters, several factors were associated with successful liberation, including higher VIS (vasoactive-inotropic score) at CRRT initiation (odds ratio [OR] 1.35 [1.12-1.63]), higher PELOD-2 (pediatric logistic organ dysfunction-2) score at CRRT initiation (OR 1.71 [1.24-2.35]), higher urine output prior to CRRT initiation (OR 1.15 [1.001-1.32]), and shorter CRRT duration (OR 0.19 [0.12-0.28]). Inability to liberate from CRRT was common in this multinational retrospective study. Modifiable and non-modifiable factors were associated with successful liberation. These results may inform the design of future clinical trials to optimize likelihood of CRRT liberation success.

Acute Kidney Injury - therapy

Adolescent

Adult

Child

Child, Preschool

Continuous Renal Replacement Therapy - methods

Female

Humans

Infant

Infant, Newborn

Logistic Models

Male

Registries - statistics & numerical data

Renal Replacement Therapy - methods

Renal Replacement Therapy - statistics & numerical data

Retrospective Studies

Treatment Outcome

Young Adult

Details

Title: Subtitle: Factors associated with successful liberation from continuous renal replacement therapy in children and young adults: analysis of the worldwide exploration of renal replacement outcomes collaborative in Kidney Disease Registry
Creators: Erin K Stenson - Children's Hospital Colorado
Issa Alhamoud - University of Iowa
Rashid Alobaidi - University of Alberta
Gabriella Bottari - Istituti di Ricovero e Cura a Carattere Scientifico
Sarah Fernandez - Hospital General Universitario Gregorio Marañón
Dana Y Fuhrman - Children's Hospital of Pittsburgh
Francesco Guzzi - Hospital of Prato
Taiki Haga - Osaka City General Hospital
Ahmad Kaddourah - Weill Cornell Medical College in Qatar
Eleonora Marinari - Bambino Gesù Children's Hospital
Tahagod Mohamed - Nationwide Children's Hospital
Catherine Morgan - University of Alberta
Theresa Mottes - Lurie Children's Hospital
Tara Neumayr - St. Louis Children's Hospital
Nicholas J Ollberding - Cincinnati Children's Hospital Medical Center
Valeria Raggi - Bambino Gesù Children's Hospital
Zaccaria Ricci - Meyer Children's Hospital
Emily See - Royal Children's Hospital
Natalja L Stanski - University of Cincinnati
Huaiyu Zang - Cincinnati Children's Hospital Medical Center
Emily Zangla - University of Minnesota
Katja M Gist - St. Louis Children's Hospital
Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Diseases (WE-ROCK) Investigators
Amy E Strong (Contributor) - Nephrology, Dialysis and Transplantation
Resource Type: Journal article
Publication Details: Intensive care medicine, Vol.50(6), pp.861-872
DOI: 10.1007/s00134-024-07336-4
PMID: 38436726
PMCID: PMC11164640
NLM abbreviation: Intensive Care Med
ISSN: 0342-4642
eISSN: 1432-1238
Grant note: K23 HL168362 / NHLBI NIH HHS R13 DK137550 / NIDDK NIH HHS UL1 TR001425 / NCATS NIH HHS K23 GM151444 / NIGMS NIH HHS
Language: English
Date published: 06/01/2024
Academic Unit: Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics
Record Identifier: 9984775023902771

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