Risk factors for adverse short-term and long-term outcomes in children with severe acute kidney injury requiring continuous kidney replacement therapy

Abstract

Background: Severe acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT) is common in critically ill children.

Methods: We conducted a single-center, retrospective cohort study of children with AKI requiring CKRT from 2011 to 2020 to determine the incidence of and risk factors for adverse short- and long-term outcomes using multivariable analysis. Patients with chronic kidney disease (CKD) and, for long-term analysis, the lack of post-discharge data, were excluded.

Results: Of 217 patients, 47% died in hospital. Hospital, intensive care unit (ICU), and ventilator days were 42.71, 26.88, and 21.04 days, respectively. Higher baseline estimated glomerular filtration rate (eGFR), vasoactive inotropic score, transfusions, and percent fluid balance (PFB) were associated with increased in-hospital mortality. Cardiac diagnosis, higher admission eGFR, PFB, CKRT duration and instances, and decreased transfusions were associated with increased ICU days. Higher admission eGFR and CKRT duration, younger age, and CVVHDF were associated with increased hospital days for discharged patients. Higher baseline eGFR, PFB, urine output (UOP), CKRT duration and instances, CVVHD, and M60 filter were associated with increased hospital days for patients who died. Higher eGFR at CKRT initiation, PFB, CKRT duration, and instances were associated with increased ventilator time. Of 98 patients followed at 3.58 years post-discharge, 16% died at 1.3 years. Increased age and UOP were associated with increased mortality. Among 82 patients who survived, 23% were at-risk for CKD and 55% developed CKD. Decreased eGFR at discharge and increased ICU and CKRT days were associated with CKD development.

Conclusions: Several modifiable risk factors correlate with adverse short-term outcomes of CKRT. Age and discharge eGFR may guide long-term prognosis and follow-up.

Keywords: Acute kidney injury; CKRT; Critical care nephrology; Long-term outcomes.