A retrospective analysis: the outcome of renal replacement therapies in critically ill children

Çeleğen, Kübra; Çeleğen, Mehmet

doi:10.1590/1806-9282.20220837

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Revista da Associação Médica Brasileira

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Sumário

Original Article • Rev. Assoc. Med. Bras. 69 (6) • 2023 • https://doi.org/10.1590/1806-9282.20220837 copy

A retrospective analysis: the outcome of renal replacement therapies in critically ill children

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

A few pediatric studies were present which focused on renal replacement therapy used for critically ill children. This research aimed to determine the ratio of utilization of intermittent hemodialysis, continuous renal replacement therapy, and peritoneal dialysis, and to study the properties and outcomes of critically ill pediatric patients who underwent renal replacement therapy.

METHODS:

Critically ill children admitted to the intensive care unit and received renal replacement therapy from February 2020 to May 2022 were included. The children were divided into three groups: hemodialysis, continuous renal replacement therapy, and peritoneal dialysis.

RESULTS:

A total of 37 patients (22 boys and 15 girls) who received renal replacement therapy met the criteria for this study. Continuous renal replacement therapy was used in 43%, hemodialysis in 38%, and peritoneal dialysis in 19%. In all, 28 (73%) children survived and 9 (27%) died in intensive care unit. The mean systolic blood pressure was significantly lower among children who received continuous renal replacement therapy (p<0.001). The need for inotropic medications and a higher PRISM III score were found to be the greatest indicators of mortality.

CONCLUSION:

The outcome of children receiving renal replacement therapy seems to be related to their needs for vasoactive drugs and the severity of the underlying disease in the continuous renal replacement therapy group relative to the other groups.

KEYWORDS:
Acute kidney injury; Continuous renal replacement therapy; Renal dialysis; Peritoneal dialysis; Pediatrics

Variables		HD (n=14)	CRRT (n=16)	PD (n=7)	p-value
Age at admission (month)		132 (3–170)	13 (3–172)	5 (3–9)^# The parameter of the group with (#) sign is significantly higher than those in the other groups.	0.049
Sex (female n/%, male n/%)		6 (42.8%), 8 (57.2%)	6 (37.5%), 10 (62.5%)	3 (42.8%), 4 (57.2%)	0.76
Weight at admission (kg)		20 (3–65)	10 (4–63)	5.5 (3–7)	0.07
Systolic blood pressure at admission (mmHg)		109.2±8.3^# The parameter of the group with (#) sign is significantly higher than those in the other groups.	69.6±6.1	82.7±8.7	<0.001
Hearth rate		133.6±28.6	137.7±22.8	144.2±21.5	0.09
Primary diagnosis
	Sepsis	1 (7.1%)	11 (68.8%)	3 (42.8%)	0.06
	ATN	7 (50%)	4 (25%)	1 (14.2%)
	HUS	3 (21.4%)	–	1 (14.2%)
	Metabolic disease	1 (7.1%)	–	2 (28.4%)
	Intoxication	2 (14.2%)	–	–
	Bone marrow transplantation	–	1 (6.2%)	–
Comorbidity
	Respiratory disorders	–	2	–	0.32
	Neurological disorders	1	1	–
	Renal disorders	1	–	–
	Metabolic disorders	1	–	2
	Hematological-oncological disorders	–	1	–
Duration of ICU (day)		16 (2–45)	12 (2–48)	33 (12–62)	0.3
Duration of RRT (day)		5.8±3.1	3.4±1.8	6.7±5.9	0.52
Mechanical ventilation support
	CMV	5 (35.7%)	10 (62.5%)	3 (42.8%)	0.27
	HFOV	–	5 (31.3%)	1 (14.2%)
	NIV	1 (7.1%)	1 (6.2%)	–
PRISM III score		6 (2–22)	18 (12–21)^# The parameter of the group with (#) sign is significantly higher than those in the other groups.	9.5 (6–12)	0.02
Vasoactive inotropic drug		2 (22.2%)	6 (85.7%)^# The parameter of the group with (#) sign is significantly higher than those in the other groups.	2 (50%)	0.01
Outcome
	Survived	13 (92.8%)	9 (56.25%)	6 (85.7%)	0.02
	Died	1 (7.2%)	7 (43.75%)^# The parameter of the group with (#) sign is significantly higher than those in the other groups.	1 (14.3%)	0.02

Variables		Survivors (n=28)	Nonsurvivors (n=9)	p-value
Age at admission (month)^* * Indicates median (min–max).		63 (3–172)	6 (5–84)	0.42
Sex (female n/%, male n/%)		10 (35.7%), 18 (64.3%)	3 (33.3%), 6 (66.7%)	0.95
Weight at admission (kg)^* * Indicates median (min–max).		15 (3–65)	6 (5–24)	0.56
Systolic blood pressure at admission (mmHg)		94.5±18.1	65.0±6.2	<0.001
Primary diagnosis
	Sepsis	9 (32.1%)	6 (66.7%)	0.14
	ATN	11 (39.3%)	1 (11.1%)
	HUS	4 (14.2%)	–
	Metabolic disease	2 (7.1%)	1 (11.1%)
	Intoxication	2 (7.1%)	0
	Bone marrow transplantation	–	1 (11.1%)
Duration of ICU (day)^* * Indicates median (min–max).		15 (2–62)	5 (2–18)	0.2
MV requirement		17 (60.7%)	9 (100%)	0.52
Mechanical ventilation support
	CMV	12 (42.9%)	6 (66.6%)	0.35
	HFOV	3 (10.7%)	3 (33.3%)
	NIV	2 (7.1%)	0
PRISM III score		10.3±6.6	18.3±0.57	<0.001
Duration of RRT (day)		5.6±3.6	2.6±1.1	0.18
Vasoactive inotropic drug		7 (41.2%)	3 (100%)	0.03

Variables	Odds ratio	95%CI	p-value
The requirement for inotropic drugs	1.8	1.05–2.1	0.04
PRISM III score	2.3	1.25–3.2	0.03
Systolic blood pressure at admission	0.98	1.12–1.5	0.09

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[1] *Corresponding author: kubractf@hotmail.com