Experience of continuous kidney replacement therapy in a tertiary care unit of a lower-middle-income country.

Abstract

Background: Information on the clinical characteristics and outcomes of children undergoing continuous kidney replacement therapy (CKRT) from lower-middle-income countries (LMIC) is limited.

Methods: Records of consecutive children 1 month to 18 years of age who underwent CKRT from Jan 2016 to Jan 2024 in a tertiary care pediatric intensive care unit (PICU) were retrospectively reviewed and analyzed for clinical and machine-related characteristics, and outcomes.

Results: Over the 8-year period, 102 patients (61.8% boys) with median age 4 (1.5-9) years underwent CKRT. Among these, 52 (51%) weighed < 15 kg, 37 (36.3%) were underweight, and 27 (26.5%) were stunted. Mean (SD) PRISM III score at admission was 17 (6.8), with 94.1% of patients ventilated and 90.2% on two or more inotropes at CKRT initiation. Septic shock (28.4%) and inborn errors of metabolism with acute decompensation (23.5%) were the most common diagnoses at PICU admission. Indications for CKRT were fluid overload, hyperammonemia or inborn errors of metabolism with acute decompensation, dyselectrolytemia, or their combination in 33.3%, 32.4%, 5.9%, and 19.6% patients, respectively. Continuous veno-venous hemodiafiltration (CVVHDF) was the most common (60.8%) modality employed, with an effluent dose of 32.8 ± 7.3 ml/kg/h. Despite heparin anticoagulation in 87.2% patients, circuit clot occurred in 28 patients, 18 (17.6%) of which led to termination of CKRT session. Overall mortality was 75%.

Conclusions: CKRT can be safely performed in critically ill children from LMIC despite the presence of significant undernutrition and multi-organ dysfunction. Further studies from similar settings are required to evolve strategies to identify modifiable risk factors for the observed high mortality.