Abstract
Rationale & Objective: There are limited studies describing the epidemiology and outcomes in children and young adults receiving continuous kidney replacement therapy (CKRT). We aimed to describe associations between patient characteristics, CKRT prescription, and survival. Study Design: Retrospective multicenter cohort study. Setting & Participants: 980 patients aged from birth to 25 years who received CKRT between 2015 and 2021 at 1 of 32 centers in 7 countries participating in WE-ROCK (Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Diseases). Exposure: CKRT for acute kidney injury or volume overload. Outcomes: Death before intensive care unit (ICU) discharge. Analytical Approach: Descriptive statistics. Results: Median age was 8.8 years (IQR, 1.6-15.0), and median weight was 26.8 (IQR, 11.6-55.0) kg. CKRT was initiated a median of 2 (IQR, 1-6) days after ICU admission and lasted a median of 6 (IQR, 3-14) days. The most common CKRT modality was continuous venovenous hemodiafiltration. Citrate anticoagulation was used in 62%, and the internal jugular vein was the most common catheter placement location (66%). 629 participants (64.1%) survived at least until ICU discharge. CKRT dose, filter type, and anticoagulation were similar in those who did and did not survive to ICU discharge. There were apparent practice variations by institutional ICU size. Limitations: Retrospective design; limited representation from centers outside the United States. Conclusions: In this study of children and young adults receiving CKRT, approximately two thirds survived at least until ICU discharge. Although variations in dialysis mode and dose, catheter size and location, and anticoagulation were observed, survival was not detected to be associated with these parameters. Plain-Language Summary: In this large contemporary epidemiological study of children and young adults receiving continuous kidney replacement therapy in the intensive care unit, we observed that two thirds of patients survived at least until ICU discharge. However, patients with comorbidities appeared to have worse outcomes. Compared with previously published reports on continuous kidney replacement therapy practice, we observed greater use of continuous venovenous hemodiafiltration with regional citrate anticoagulation.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 406-415.e1 |
| Journal | American Journal of Kidney Diseases |
| Volume | 84 |
| Issue number | 4 |
| DOIs | |
| State | Published - Oct 2024 |
Funding
Emily Ahern, CPNP, DNP; Ayse Akcan Arikan, MD; Issa Alhamoud, MD; Rashid Alobaidi, MD, MSc; Pilar Anton-Martin, MD, PhD; Matthew Barhight, MD, MS; Abby Basalely, MD, MS; Amee M. Bigelow, MD, MS; Gabriella Bottari, MD; Michaela Collins, BA; Denise Colosimo, MD; Gerard Cortina, MD; Mihaela A. Damian, MD, MPH; Sara de la Mata Navazo, MD; Gabrielle DeAbreu, MD; Akash Deep, MD; Kathy L. Ding, BS; Kristin J. Dolan, MD; Sarah N. Fernandez Lafever, MD, PhD; Dana Y. Fuhrman, DO, MS; Ben Gelbart, MBBS; Stephen M. Gorga, MD, MSc; Francesco Guzzi, MD; Isabella Guzzo, MD; Taiki Haga, MD; Elizabeth Harvey, MD; Denise C. Hasson, MD; Taylor Hill-Horowitz, BS; Haleigh Inthavong, BS, MS; Ahmad Kaddourah, MD, MS; Sarah Korn, DO; Kelli A. Krallman, BSN, MS; David M. Kwiatkowski, MD, MSc; Jasmine Lee, MSc; Laurance Lequier, MD; Tina Madani Kia, BS; Kenneth E. Mah, MD, MS; Eleonora Marinari, MD; Susan D. Martin, MD; Tahagod H. Mohamed, MD; Catherine Morgan, MD, MSc; Theresa A. Mottes, APRN; Siva Namachivayam, MBBS; Tara M. Neumayr, MD; Jennifer Nhan, MD, MS; Abigail O'Rourke, MD; Dua Qutob, MD; Valeria Raggi, MD; Zaccaria Ricci, MD; Zachary A. Rumlow, DO; Emily See, MBBS; David T. Selewski, MD, MSCR; Carmela Serpe, MSc, PhD; Alyssa Serratore, RN, MSc; Ananya Shah, BS; H. Stella Shin, MD; Danielle E. Soranno, MD; Natalja L. Stanski, MD; Erin K. Stenson, MD; Amy E. Strong, MD, MSCE; Susan A. Taylor, MSc; Sameer V. Thadani, MD; Amanda M. Uber, DO; Brynna Van Wyk, ARNP, MSN; Emily E. Zangla, DO; and Michael Zappitelli, MD, MSc. Children's Hospital Colorado, University of Colorado School of Medicine (EA, EKS) and School of Medicine, University of Colorado (KLD, AShah, EKS), Aurora, CO; Baylor College of Medicine, Texas Children's Hospital, Houston, TX (AAA, KJD, HI); University of Iowa Stead Family Children's Hospital, Carver College of Medicine, Iowa City, IA (IA, ZAR, AES, BVW); University of Alberta, Edmonton, AB (RA, LL, TMK, CM) and Hospital for Sick Children, Toronto, ON (EH, JL, MZ), Canada; Le Bonheur Children's Hospital, Memphis, TN (PA-M); Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL (MB, TAM); Cohen Children's Medical Center, Zucker School of Medicine, New Hyde Park (AB, GD, AO), NYU Langone Health, Hassenfeld Children's Hospital, New York (DCH), Westchester Medical Center, Westchester (SK), and Golisano Children's Hospital at University of Rochester Medical Center, Rochester (SDM), NY; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus (AMB, TH-H, THM) and Cincinnati Children's Hospital Medical Center; University of Cincinnati College of Medicine, Cincinnati (MC, IG, KAK, NLS), OH; Bambino Ges\u00F9 Children Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome (GM, EM, VR, CS), Meyer Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Florence (DC, ZR), and Santo Stefano Hospital, Prato (FG), Italy; Medical University of Innsbruck, Innsbruck, Austria (GC); Stanford University School of Medicine (MAD, DMK, KEM) and Lucile Packard Children's Hospital (DMK), Palo Alto, CA; School of Medicine, Gregorio Mara\u00F1\u00F3n University Hospital, Madrid, Spain (SdlMN, SNFL); King's College Hospital, London, United Kingdom (AD, SAT); University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA (DYF); Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, Australia (BG, AN, ES, ASerratore); University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, MI (SMG); Osaka City General Hospital, Osaka, Japan (TH); Sidra Medicine and Weill Cornell Medicine Qatar (AK, DQ), Doha, Qatar; Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (TMN); Children's National Hospital, Washington, DC (JN); Medical University of South Carolina, Charleston, SC (DTS); Children's Healthcare of Atlanta, Emory University, Atlanta, GA (HSS); Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN (DES); University of Nebraska Medical Center, Children's Hospital & Medical Center, Omaha, NE (AMU); and University of Minnesota, Minneapolis, MN (EEZ). Michelle C. Starr, MD, Katja M. Gist, DO, Huaiyu Zang, PhD, Nicholas J. Ollberding, PhD, Shanthi Balani, MD, Andrea Cappoli, MD, Eileen Ciccia, MD, Catherine Joseph, MD, Aadil Kakajiwala, MD, Aaron Kessel, MD, Melissa Muff-Luett, MD, Mar\u00EDa J. Santiago Lozano, MD, Matthew Pinto, MD, Stephanie Reynaud, MD, Sonia Solomon, DO, Cara Slagle, MD, Rachana Srivastava, MD, Weiwen V. Shih, MD, Tennille Webb, MD, and Shina Menon, MD. Study concept: MCS, SM, KMG; study design: MCS, SM, KMG, SB, AC, EC, CJ, AK, AK, MM-L, MSL, MP, SR, SS, CS, RS, WVS, TW; data analysis: MCS, SM; data interpretation: MCS, SM, SB, AC, EC, CJ, AK, AK, MM-L, MSL, MP, SR, SS, CS, RS, WVS, TW; statistical analysis: HZ, NJO; support and mentorship: KMG. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual's own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature if appropriate. This study was funded in part by the Gerber Foundation (KMG, SM). MCS is supported in part by K12TR004415. REDCap at Cincinnati Children's Hospital Medical Center is funded and supported by the Center for Clinical and Translational Science and Training grant support (UL1TR001425). The funding sources for this study had no role in the design, conduct, collection, management, analysis, and interpretation of the data, nor the preparation, review, or decision to submit the manuscript for publication. Dr Gist is a consultant for Bioporto Diagnostics and Potrero Medical. Dr Menon is a consultant for Medtronic Inc and Nuwellis Inc. Dr Mottes is a consultant for Medtronic Inc. Dr Muff-Luett is a consultant for Medtronic Inc. Dr Zappitelli has completed consultant work for Bioporto Diagnostics Inc. The remaining authors declare that they have no relevant financial interests. The authors thank the following individuals for their contributions to data collection, cleaning, and management: T. Christine E. Alvarez, MHI, RN, Cheryl L. Brown, BS, Christopher J. Meyer, BA, AA (Cincinnati Children's Hospital Medical Center, Cincinnati, OH); Elizabeth Bixler, BS (Baylor College of Medicine, Texas Children's Hospital, Houston, TX); Erica Blender Brown, MA, CRA, Katherine Twombley, MD (Medical University of South Carolina, Charleston, SC); Ambra Burrell, BA, Kate Kanwar, BA, MS (Nationwide Children's Hospital, Columbus, OH); Anwesh Dash, BS, Joshua Porter, BS, Elizabeth Schneider, BS, Vidushi Sinha, BS, Janet Wang, BS, Megan Woods, BS, Alison Zong, BS (University of Tennessee Health Science Center College of Medicine, Memphis, TN); Jennifer L. Ehrlich, RN, MHA, Brynna Van Wyk, MSN, ARNP, CPNP (University of Iowa Stead Family Children's Hospital, Carver College of Medicine, Iowa City, IA); Simrandeep Farma, HBSc (Hospital for Sick Children, Toronto, ON, Canada); Kim Gahring, RN, BSN, CCRN, Jennifer Lusk, BSN, RN, CCRN (Children's Hospital Colorado, Aurora, CO); Barbara Gales, RN (UCLA Mattel Children Hospital, Los Angeles, CA); Madison R. Hilgenkamp (University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE); Sonal Jain, MS (Seattle Children's Hospital, Seattle, WA); Katherine Plomaritas, BSN, RN (University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI); Jessica Potts, BSN, RN (Children's of Alabama/University of Alabama at Birmingham, Birmingham, AL); Alyssa Serratore, BNurs, GDipNP(PIC), RN, MSc (Royal Children's Hospital, Melbourne, VIC, Australia); P.J. Strack, RN, BSN, CCRN (Children's Mercy Hospital, Kansas City, MO); Sue Taylor, RN (King's College Hospital, London, United Kingdom); Samantha Wallace, MS (Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN); Marcia Zinger, RN (Cohen Children's Medical Center, New Hyde Park, NY). Deidentified summary data are available through the WE-ROCK collaborative. Data dictionaries, in addition to study protocol and the statistical analysis plan, will be made available upon request. More information about the process and available data can be obtained by contacting the corresponding author (SM). The data from the WE-ROCK collaborative will be made available to researchers who provide a methodologically sound proposal for use in achieving the goals of the approved proposal following an application process and execution of a data-use agreement as required by the institutional review board at the Cincinnati Children's Hospital Medical as part of the approval of this collaborative study. Presented in part at the 28th Annual International Conference on Continuous Renal Replacement Therapies, March 30, 2023, San Diego, CA, and the Pediatric Academic Societies Annual Meeting, April 29, 2023, Washington, DC. Received August 2, 2023. Evaluated by 3 external peer reviewers, with direct editorial input from a Statistics/Methods Editor, an Associate Editor, and the Editor-in-Chief. Accepted in revised form December 8, 2023. This study was funded in part by the Gerber Foundation (KG, SM). M.S is supported in part by K12TR004415. REDCap at Cincinnati Children\u2019s Hospital Medical Center is funded and supported by the Center for Clinical and Translational Science and Training grant support (UL1TR001425). The funding sources for this study had no role in the design, conduct, collection, management, analysis, and interpretation of the data, nor the preparation, review, or decision to submit the manuscript for publication.
Keywords
- Continuous kidney replacement therapy
- WE-ROCK
- acute kidney injury
- database
- fluid overload
- intensive care unit
- pediatric
- technique
ASJC Scopus subject areas
- Nephrology
