Functional outcomes in pediatric patients on renal replacement therapy in a worldwide registry

Kristin J Dolan; Katja M Gist; Abby Basalely; Gabriella Bottari; Abhishek Chakraborty; Mihaela Damian; Dana Fuhrman; Denise C Hasson; Catherine Joseph; Dave Kwiatkowski; Susan Martin; Jenn Nhan; Nicolas Ollberding; David T Selewski; Danielle Soranno; Michelle C Starr; Amy Strong; Sameer Thadani; Huaiyu Zang; Ayse Akcan Arikan; WE-ROCK Collaborative

doi:10.1093/ndt/gfaf067

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Functional outcomes in pediatric patients on renal replacement therapy in a worldwide registry

Journal article

Peer reviewed

Functional outcomes in pediatric patients on renal replacement therapy in a worldwide registry

Kristin J Dolan, Katja M Gist, Abby Basalely, Gabriella Bottari, Abhishek Chakraborty, Mihaela Damian, Dana Fuhrman, Denise C Hasson, Catherine Joseph, Dave Kwiatkowski, …

Nephrology, dialysis, transplantation, Vol.40(10), pp.1919-1930

09/29/2025

DOI: 10.1093/ndt/gfaf067

PMCID: PMC12709130

PMID: 40258340

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https://pmc.ncbi.nlm.nih.gov/articles/PMC12709130/View

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Abstract

Mortality rates of children supported with continuous renal replacement therapy (CRRT) have improved, yet morbidity remains high. We aimed to evaluate the functional outcomes of children receiving CRRT using functional status scale (FSS). We hypothesized that children receiving CRRT will have worse FSS compared to their baseline, acquire new morbidity at hospital discharge and 6-and 12-months post discharge, and lack of renal recovery will contribute to worsening functional status. This is a retrospective chart review from The Worldwide Exploration of Renal Replacement Outcomes Collaborate in Kidney Disease (WE-ROCK), an international multi-center registry. 28 centers across 5 countries participated in this analysis. Children birth to 25 years, on CRRT for AKI or FO, were included. Patients with underlying kidney disease, on extracorporeal membrane oxygenation, and non-survivors were excluded. FSS was collected at discharge (n = 527), 6 months (n = 387), and 12 months post-discharge (n = 344). The primary outcome was FSS at discharge and 6 months. Secondary outcomes included: new morbidity at discharge and 6 months; FSS at 12 months; and the impact of renal recovery on functional outcomes. 527 patients had median FSS of 7[6,9] at hospital discharge. 39%(n = 204) had worse FSS. 18%(95/527) acquired a new morbidity at discharge. Predictors of FSS at discharge were baseline FSS(OR 1.30[95% CI 1.11-1.52]), weight(OR 0.99[95% CI 0.98-0.9997]), comorbidities(OR 1.88[95% CI 1.16-3.04]), mechanical ventilation(OR 1.72(95%CI 1.04-2.85]), and sepsis on ICU admission(OR 1.46[95% CI 1.01-2.21]). 387 patients had median FSS score of 6[6,8] at 6 months. 10%(n = 39/387) acquired new morbidity at 6 months. The significant predictors of FSS at 6 months were FSS at discharge(OR 2.36 [95%CI 1.95-2.84]) and presence of comorbidities(OR 1.77[95%CI 1.03-3.06]). This is the first large, multi-center study evaluating functional outcomes of children on CRRT. Persistent morbidity following discharge emphasizes the importance of comprehensive identification and multidisciplinary follow up to optimize patient outcomes.

Intensive Care

Pediatrics

Quality of Life

dialysis

AKI

Details

Title: Subtitle: Functional outcomes in pediatric patients on renal replacement therapy in a worldwide registry
Creators: Kristin J Dolan - Baylor College of Medicine
Katja M Gist
Abby Basalely - Cohen Children's Medical Center
Gabriella Bottari - Bambino Gesù Children's Hospital
Abhishek Chakraborty - Le Bonheur Children's Hospital
Mihaela Damian - Stanford University School of Medicine
Dana Fuhrman - University of Pittsburgh Medical Center
Denise C Hasson - NYU Langone Health
Catherine Joseph - Baylor College of Medicine
Dave Kwiatkowski - Stanford University School of Medicine
Susan Martin - University of Rochester Medical Center
Jenn Nhan - Children's National Hospital, Washington DC, USA
Nicolas Ollberding
David T Selewski - Medical University of South Carolina
Danielle Soranno - Indiana University School of Medicine
Michelle C Starr - Indiana University School of Medicine
Amy Strong - University of Iowa
Sameer Thadani - Baylor College of Medicine
Huaiyu Zang
Ayse Akcan Arikan - Baylor College of Medicine
WE-ROCK Collaborative
Resource Type: Journal article
Publication Details: Nephrology, dialysis, transplantation, Vol.40(10), pp.1919-1930
DOI: 10.1093/ndt/gfaf067
PMID: 40258340
PMCID: PMC12709130
NLM abbreviation: Nephrol Dial Transplant
ISSN: 1460-2385
eISSN: 1460-2385
Publisher: OXFORD UNIV PRESS
Grant note: Heart Institute Research Core (CORE) at Cincinnati Children's Hospital Medical CenterCenter for Clinical and Translational Science and Training grant support: UL1TR001425
This study was supported by the Heart Institute Research Core (CORE) at Cincinnati Children's Hospital Medical Center. REDCap at Cincinnati Children's Hospital Medical Center was funded and supported by the Center for Clinical and Translational Science and Training grant support (UL1TR001425). The funding source for this study had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or decision to submit the manuscript for publication.
Language: English
Electronic publication date: 04/21/2025
Date published: 09/29/2025
Academic Unit: Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics
Record Identifier: 9984812947002771

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