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Indian Journal of Pediatrics
Published in: Indian Journal of Pediatrics 4/2019

01-04-2019 | Acute Kidney Injury | Original Article

Clinical Features and Indications Associated with Mortality in Continuous Renal Replacement Therapy for Pediatric Patients

Authors: Guntulu Sık, Asuman Demirbuga, Seda Günhar, Kemal Nisli, Agop Citak

Published in: Indian Journal of Pediatrics | Issue 4/2019

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Abstract

Objectives

To identify prognostic factors and indications in patients receiving continuous renal replacement therapy (CRRT) in the pediatric intensive care unit (PICU), and to demonstrate their effect on mortality.

Methods

A total of 63 patients admitted between 2011 and 2014 were included in the study. The demographic information, pediatric risk of mortality (PRISM) scores, vasoactive-inotropic score, indication for CRRT, time of starting CRRT, presence of fluid overload, durations of CRRT, and pediatric intensive care unit (PICU) stay were compared between survivors and non-survivors.

Results

The overall rate of survival was 69,8%. The most common indication for CRRT was fluid overload (31.7%) followed by acute attacks of metabolic diseases (15.9%), and resistant metabolic acidosis (15.9%). The median duration of CRRT was 58 (IQR 24–96) h. The most common CRRT modality was continuous venovenous hemodiafiltration. The CRRT modality was not different between survivors and nonsurvivors. Sepsis, as the diagnosis for admission to intensive care unit was significantly related to decreased survival when compared to acute kidney injury and acute attacks of metabolic diseases. Patients with fluid overload had significantly increased rate of death, CRRT duration, use of mechanical ventilation, and PICU stay.

Conclusions

The CRRT, can be effectively used for removal of fluid overload, treatment of acute attacks of metabolic diseases, and other indications in critically ill pediatric patients. It has a positive effect on mortality in high-risk PICU patients. This treatment modality can be used more frequently in pediatric intensive care unit with improved patient outcomes, and should be focused on starting therapy in early stages of fluid overload.
Literature
1.
Symons JM, Chua AN, Somers MJ, et al. Demographic characteristics of pediatric continuous renal replacement therapy: a report of the prospective pediatric continuous renal replacement therapy registry. Clin J Am Soc Nephrol. 2007;2:732–8.CrossRefPubMed
2.
Boschee ED, Cave DA, Garros D, et al. Indications and outcomes in children receiving renal replacement therapy in pediatric intensive care. J Crit Care. 2014;29:37–42.CrossRefPubMed
3.
Lowrie LH. Renal replacement therapies in pediatric multiorgan dysfunction syndrome. Pediatr Nephrol. 2000;14:6–12.CrossRefPubMed
4.
Goldstein SL, Somers MJ, Baum MA, et al. Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int. 2005;67:653–8.CrossRefPubMed
5.
Foland JA, Fortenberry JD, Warshaw BL, et al. Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis. Crit Care Med. 2004;32:1771–6.CrossRefPubMed
6.
Goldstein SL, Currier H, Graf C, Cosio CC, Brewer ED, Sachdeva R. Outcome in children receiving continuous venovenous hemofiltration. Pediatrics. 2001;107:1309–12.CrossRefPubMed
7.
Kellum JA, Lameire N. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary. On behalf of the KDIGO guideline AKI group. Crit Care. 2013;17:204.CrossRefPubMedPubMedCentral
8.
Kwiatkowski DM, Krawczeski CD. Acute kidney injury and fluid overload in infants and children after cardiac surgery. Pediatr Nephrol. 2017;32:1509–17.CrossRefPubMed
9.
Al-Ayed T, Siddiqui NR, Alturki A, Aljofan F. Outcome of continuous renal replacement therapy in critically ill children: a retrospective cohort study. Ann Saudi Med. 2018;38:260–8.CrossRefPubMedPubMedCentral
10.
11.
Hayes LW, Oster RA, Tofil NM, Tolwani AJ. Outcomes of critically ill children requiring continuous renal replacement therapy. J Crit Care. 2009;24:394–400.CrossRefPubMed
12.
Bagshaw SM, Uchino S, Bellomo R, et al. Beginning and ending supportive therapy for the kidney (BEST kidney) investigators. Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury. J Crit Care. 2009;24:129–40.CrossRefPubMed
13.
Sutherlan SM, Zappitelli M, Alexander SR, et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis. 2010;55:316–25.CrossRef
14.
Gillespie RS, Seidel K, Symons JM. Effect of fluid overload and dose of replacement fluid on survival in hemofiltration. Pediatr Nephrol. 2004;19:1394–9.CrossRefPubMed
15.
Mitchell JP, Schuller D, Calandrino FS, Schuster DP. Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization. Am Rev Respir Dis. 1992;145:990–8.CrossRefPubMed
16.
Choi SJ, Ha E-J, Jhang WK, Park SJ. Factors associated with mortality in continuous renal replacement therapy for pediatric patients with acute kidney ınjury. Pediatr Crit Care Med. 2017;18:e56–61.CrossRefPubMed
17.
Modem V, Thompson M, Gollhofer D, Dhar AV, Quigley R. Timing of continuous renal replacement therapy and mortality in critically ill children. Crit Care Med. 2014;42:943–53.CrossRefPubMed
18.
Arikan AA, Zappitelli M, Goldstein SL, Naipaul A, Jefferson LS, Loftis LL. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. Pediatr Crit Care Med. 2012;13:253–8.CrossRefPubMed
19.
Sanchez-de-Toledo J, Perez-Ortiz A, Gil L, et al. Early initiation of renal replacement therapy in pediatric heart surgery ıs associated with lower mortality. Pediatr Cardiol. 2016;37:623–8.CrossRefPubMed
20.
Upadya A, Tilluckdharry L, Muralidharan V, Amoateng-Adjepong Y, Manthous CA. Fluid balance and weaning outcomes. Intensive Care Med. 2005;31:1643–7.CrossRefPubMed
21.
Valentine SL. Sapru a, Higgerson RA, et al; pediatric acute lung injury and Sepsis Investigator's (PALISI) network; acute respiratory distress syndrome clinical research network (ARDSNet). Fluid balance in critically ill children with acute lung injury. Crit Care Med. 2012;40:2883–9.CrossRefPubMedPubMedCentral
22.
23.
Rustagi RS, Arora K, Das RR, Pooni PA, Singh D. Incidence, risk factors and outcome of acute kidney injury in critically ill children - a developing country perspective. Paediatr Int Child Health. 2017;37:35–41.CrossRefPubMed
24.
Lai TS, Shiao CC, Wang JJ, et al. Earlier versus later initiation of renal replacement therapy among critically ill patients with acute kidney injury: a systematic review and meta-analysis of randomized controlled trials. Ann Intensive Care. 2017;7:38.CrossRefPubMedPubMedCentral
25.
Karvellas CJ, Farhat MR, Sajjad I, et al. A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis. Crit Care. 2011;15:R 72.CrossRef
26.
Gulla KM, Sachdev A, Gupta D, Gupta N, Anand K, Pruthi PK. Continuous renal replacement therapy in children with severe sepsis and multiorgan dysfunction - a pilot study on timing of initiation. Indian J Crit Care Med. 2015;19:613–7.CrossRefPubMedPubMedCentral
27.
Bellomo R, Cass A, Cole L, et al; Renal Replacement Therapy Study Investigators. An observational study fluid balance and patient outcomes in the randomized evaluation of normal vs augmented level of replacement therapy trial. Crit Care Med. 2012;40:1753–60.CrossRefPubMed
28.
Selewski DT, Cornell TT, Blatt NB, et al. Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy. Crit Care Med. 2012;40:2694–9.CrossRefPubMedPubMedCentral
Metadata
Title
Clinical Features and Indications Associated with Mortality in Continuous Renal Replacement Therapy for Pediatric Patients
Authors
Guntulu Sık
Asuman Demirbuga
Seda Günhar
Kemal Nisli
Agop Citak
Publication date
01-04-2019
Publisher
Springer India
Published in
Indian Journal of Pediatrics / Issue 4/2019
Print ISSN: 0019-5456
Electronic ISSN: 0973-7693
DOI
https://doi.org/10.1007/s12098-019-02868-w

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