Outcome of continuous renal replacement therapy in critically ill children: a retrospective cohort study
BACKGROUND: Continuous renal replacement therapy (CRRT) has become the preferred mode of dialysis to support critically ill children with acute kidney injury. However, there are limited pediatric data on CRRT use, especially in our region. OBJECTIVE: Determine the outcome of CRRT among critically il...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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King Faisal Specialist Hospital and Research Centre
2018-07-01
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| Series: | Annals of Saudi Medicine |
| Online Access: | https://www.annsaudimed.net/doi/full/10.5144/0256-4947.2018.260 |
| _version_ | 1811232622330773504 |
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| author | Tareq Al-Ayed Naveed ur Rahman Siddiqui Abdullah Alturki Fahad Aljofan |
| author_facet | Tareq Al-Ayed Naveed ur Rahman Siddiqui Abdullah Alturki Fahad Aljofan |
| author_sort | Tareq Al-Ayed |
| collection | DOAJ |
| description | BACKGROUND: Continuous renal replacement therapy (CRRT) has become the preferred mode of dialysis to support critically ill children with acute kidney injury. However, there are limited pediatric data on CRRT use, especially in our region. OBJECTIVE: Determine the outcome of CRRT among critically ill children. DESIGN: Retrospective cohort study. SETTING: Pediatric intensive care unit. PATIENTS AND METHODS: The study included critically ill children 1-14 years of age who underwent CRRT from July 2009 to June 2015. We report the underlying diagnosis, demographics, indications and modality of CRRT, and associated risk factors. Statistical analyses were used to identify risk factors associated with mortality. MAIN OUTCOME MEASURES: Mortality and associated risk factors with use of CRRT. SAMPLE SIZE: 96 RESULTS: The mean age was 6.0 (standard deviation, 4.4) years, with a male preponderance in the age group from 1-10 years which comprised almost 60% of the study group. The most common primary diagnoses were malignancies [37.5% (36/96)] followed by primary renal diseases [19.8% (19/96)], and immunodeficiency [16.7% (16/96)]. The most common indication for CRRT was fluid overload [67.2% (65/96)] followed by tumor lysis syndrome [18.8%(18/96)], and metabolic encephalopathy [9.4%(9/96)]. The median length of CRRT was 66 hours (IQR, 35.5-161.4), with a median average circuit life of 30.9 hours (IQR, 16.4-45.0). The most common CRRT catheter site was the internal jugular vein [77.1% (74/96)], followed by the femoral vein [18.8%(18/96)] with continuous venovenous hemodiafiltration [82.3%(79/96)] being the most common CRRT modality used. The mortality rate among critically ill children requiring CRRT was 50% (48/96). There was an increased mortality rate among children with hematological diseases (100%, 10/10), immunodeficiency (86.6%, 13/16) and in children who had undergone stem cell transplantation (90.0%, 27/30), with the least mortality in primary renal disease (15.8% (3/19). We identified septic shock and use of inotropic support as being independently associated with mortality in a multivariate analysis. CONCLUSION: The overall mortality rate among critically ill children who underwent CRRT was 50% with significantly increased mortality among patients with hematological diseases, immunodeficiency, and in children who had undergone stem cell transplantation. Septic shock and use of inotropic support were associated with mortality. LIMITATIONS: Retrospective and single center data that is not generalizable. CONFLICT OF INTEREST: None. |
| first_indexed | 2024-04-12T11:05:59Z |
| format | Article |
| id | doaj.art-b894ddc3049a4a09b874f89616543454 |
| institution | Directory Open Access Journal |
| issn | 0256-4947 0975-4466 |
| language | English |
| last_indexed | 2024-04-12T11:05:59Z |
| publishDate | 2018-07-01 |
| publisher | King Faisal Specialist Hospital and Research Centre |
| record_format | Article |
| series | Annals of Saudi Medicine |
| spelling | doaj.art-b894ddc3049a4a09b874f896165434542022-12-22T03:35:45ZengKing Faisal Specialist Hospital and Research CentreAnnals of Saudi Medicine0256-49470975-44662018-07-0138426026810.5144/0256-4947.2018.260asm-4-260Outcome of continuous renal replacement therapy in critically ill children: a retrospective cohort studyTareq Al-Ayed0Naveed ur Rahman Siddiqui1Abdullah Alturki2Fahad Aljofan3From the Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaFrom the Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaBACKGROUND: Continuous renal replacement therapy (CRRT) has become the preferred mode of dialysis to support critically ill children with acute kidney injury. However, there are limited pediatric data on CRRT use, especially in our region. OBJECTIVE: Determine the outcome of CRRT among critically ill children. DESIGN: Retrospective cohort study. SETTING: Pediatric intensive care unit. PATIENTS AND METHODS: The study included critically ill children 1-14 years of age who underwent CRRT from July 2009 to June 2015. We report the underlying diagnosis, demographics, indications and modality of CRRT, and associated risk factors. Statistical analyses were used to identify risk factors associated with mortality. MAIN OUTCOME MEASURES: Mortality and associated risk factors with use of CRRT. SAMPLE SIZE: 96 RESULTS: The mean age was 6.0 (standard deviation, 4.4) years, with a male preponderance in the age group from 1-10 years which comprised almost 60% of the study group. The most common primary diagnoses were malignancies [37.5% (36/96)] followed by primary renal diseases [19.8% (19/96)], and immunodeficiency [16.7% (16/96)]. The most common indication for CRRT was fluid overload [67.2% (65/96)] followed by tumor lysis syndrome [18.8%(18/96)], and metabolic encephalopathy [9.4%(9/96)]. The median length of CRRT was 66 hours (IQR, 35.5-161.4), with a median average circuit life of 30.9 hours (IQR, 16.4-45.0). The most common CRRT catheter site was the internal jugular vein [77.1% (74/96)], followed by the femoral vein [18.8%(18/96)] with continuous venovenous hemodiafiltration [82.3%(79/96)] being the most common CRRT modality used. The mortality rate among critically ill children requiring CRRT was 50% (48/96). There was an increased mortality rate among children with hematological diseases (100%, 10/10), immunodeficiency (86.6%, 13/16) and in children who had undergone stem cell transplantation (90.0%, 27/30), with the least mortality in primary renal disease (15.8% (3/19). We identified septic shock and use of inotropic support as being independently associated with mortality in a multivariate analysis. CONCLUSION: The overall mortality rate among critically ill children who underwent CRRT was 50% with significantly increased mortality among patients with hematological diseases, immunodeficiency, and in children who had undergone stem cell transplantation. Septic shock and use of inotropic support were associated with mortality. LIMITATIONS: Retrospective and single center data that is not generalizable. CONFLICT OF INTEREST: None.https://www.annsaudimed.net/doi/full/10.5144/0256-4947.2018.260 |
| spellingShingle | Tareq Al-Ayed Naveed ur Rahman Siddiqui Abdullah Alturki Fahad Aljofan Outcome of continuous renal replacement therapy in critically ill children: a retrospective cohort study Annals of Saudi Medicine |
| title | Outcome of continuous renal replacement therapy in critically ill children: a retrospective cohort study |
| title_full | Outcome of continuous renal replacement therapy in critically ill children: a retrospective cohort study |
| title_fullStr | Outcome of continuous renal replacement therapy in critically ill children: a retrospective cohort study |
| title_full_unstemmed | Outcome of continuous renal replacement therapy in critically ill children: a retrospective cohort study |
| title_short | Outcome of continuous renal replacement therapy in critically ill children: a retrospective cohort study |
| title_sort | outcome of continuous renal replacement therapy in critically ill children a retrospective cohort study |
| url | https://www.annsaudimed.net/doi/full/10.5144/0256-4947.2018.260 |
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