Prognostic Factors in Children with Acute Kidney Injury Requiring Continuous Renal Replacement Therapy.

IF 2.2 3区医学 Q3 HEMATOLOGY Blood Purification Pub Date : 2024-01-01 Epub Date: 2024-01-05 DOI:10.1159/000536018

Jhao-Jhuang Ding, Shao-Hsuan Hsia, Tang-Her Jaing, Jing-Long Huang, Jainn-Jim Lin, Shih-Hsiang Chen, Shih-Hua Lin, Min-Hua Tseng

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Abstract

Introduction: This study aimed to evaluate prognostic factors and outcomes in a single-center PICU cohort that received continuous renal replacement therapy (CRRT).

Methods: This retrospective study analyzed clinical characteristics, laboratory data, and outcomes. Ninety-day mortality and advanced chronic kidney disease (CKD) (eGFR <60 mL/min/1.73 m2) were defined as primary and secondary outcomes, respectively.

Results: Seventy-five patients were enrolled, all of whom received CRRT for indications including acute kidney injury with complicated refractory metabolic acidosis, electrolyte derangement, and existed or impending fluid overload. The 90-day mortality and advanced CKD were 53% and 29%, respectively. Multivariate Cox regression analysis demonstrated that only underlying bone marrow transplantation (BMT) (HR 4.58; 95% CI: 2.04-10.27) and a high pSOFA score (HR 1.12; 95% CI: 1.01-1.23) were independent risk factors for 90-day mortality. Among survivors, ten developed advanced CKD on the 90th day, and this group had a higher serum fibrinogen level (OR 1.01; 95% CI: 1.01-1.03) at the start of CRRT.

Conclusion: In critically ill children with AKI requiring CRRT, post-BMT and high pSOFA scores are independent risk factors for 90-day mortality. Additionally, a high serum fibrinogen level at the initiation of CRRT is associated with the development of advanced CKD.

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需要持续肾脏替代疗法的急性肾损伤患儿的预后因素。

简介：本研究旨在评估接受持续肾脏替代治疗（CRRT）的单中心重症监护病房队列的预后因素和预后结果：本研究旨在评估接受持续肾脏替代疗法（CRRT）的单中心重症监护病房队列的预后因素和结果：这项回顾性研究分析了临床特征、实验室数据和预后。九十天死亡率和晚期慢性肾脏病（CKD）（eGFR 结果：75名患者接受了CRRT治疗，其适应症包括急性肾损伤并发难治性代谢性酸中毒、电解质紊乱以及存在或即将出现的体液超负荷。90 天死亡率和晚期 CKD 分别为 53% 和 29%。多变量考克斯回归分析表明，只有骨髓移植（BMT）（HR 4.58；95% CI 2.04-10.27）和高 pSOFA 评分（HR 1.12；95% CI 1.01-1.23）是 90 天死亡率的独立风险因素。在幸存者中，有10人在第90天发展为晚期慢性肾功能衰竭，而这部分人在开始接受CRRT时血清纤维蛋白原水平较高（OR 1.01；95% CI 1.01-1.03）：结论：在需要进行 CRRT 的 AKI 重症患儿中，BMT 后和高 pSOFA 评分是 90 天死亡率的独立风险因素。此外，开始 CRRT 时血清纤维蛋白原水平较高与晚期 CKD 的发展有关。

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来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.