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Factors associated with successful liberation from continuous renal replacement therapy in children and young adults: analysis of the worldwide exploration of renal replacement outcomes collaborative in Kidney Disease Registry.
Stenson, Erin K; Alhamoud, Issa; Alobaidi, Rashid; Bottari, Gabriella; Fernandez, Sarah; Fuhrman, Dana Y; Guzzi, Francesco; Haga, Taiki; Kaddourah, Ahmad; Marinari, Eleonora; Mohamed, Tahagod; Morgan, Catherine; Mottes, Theresa; Neumayr, Tara; Ollberding, Nicholas J; Raggi, Valeria; Ricci, Zaccaria; See, Emily; Stanski, Natalja L; Zang, Huaiyu; Zangla, Emily; Gist, Katja M.
Afiliação
  • Stenson EK; Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA. erin.stenson@gmail.com.
  • Alhamoud I; Carver College of Medicine, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA.
  • Alobaidi R; University of Alberta, Edmonton, Canada.
  • Bottari G; Bambino Gesù, Children's Hospital, IRCCS, Rome, Italy.
  • Fernandez S; School of Medicine, Gregorio Marañón University Hospital, Madrid, Spain.
  • Fuhrman DY; University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
  • Guzzi F; Santo Stefano Hospital, Prato, Italy.
  • Haga T; Osaka City General Hospital, Osaka, Japan.
  • Kaddourah A; Sidra Medicine and Weill Cornell Medicine, Doha, Qatar.
  • Marinari E; Bambino Gesù, Children's Hospital, IRCCS, Rome, Italy.
  • Mohamed T; Nationwide Children's Hospital, The Kidney and Urinary Tract Center, The Ohio State University College of Medicine, Columbus, OH, USA.
  • Morgan C; University of Alberta, Edmonton, Canada.
  • Mottes T; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
  • Neumayr T; St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA.
  • Ollberding NJ; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
  • Raggi V; Bambino Gesù, Children's Hospital, IRCCS, Rome, Italy.
  • Ricci Z; Department of Pediatrics, Pediatric Intensive Care Unit, Meyer Children's Hospital, IRCCS, Florence, Italy.
  • See E; Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia.
  • Stanski NL; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
  • Zang H; Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
  • Zangla E; University of Minnesota, Minneapolis, MN, USA.
  • Gist KM; St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA.
Intensive Care Med ; 50(6): 861-872, 2024 Jun.
Article em En | MEDLINE | ID: mdl-38436726
ABSTRACT

PURPOSE:

Continuous renal replacement therapy (CRRT) is used for supportive management of acute kidney injury (AKI) and disorders of fluid balance (FB). Little is known about the predictors of successful liberation in children and young adults. We aimed to identify the factors associated with successful CRRT liberation.

METHODS:

The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease study is an international multicenter retrospective study (32 centers, 7 nations) conducted from 2015 to 2021 in children and young adults (aged 0-25 years) treated with CRRT for AKI or FB disorders. Patients with previous dialysis dependence, tandem extracorporeal membrane oxygenation use, died within the first 72 h of CRRT initiation, and those who never had liberation attempted were excluded. Patients were categorized based on first liberation attempt reinstituted (resumption of any dialysis within 72 h) vs. success (no receipt of dialysis for ≥ 72 h). Multivariable logistic regression was used to identify factors associated with successful CRRT liberation.

RESULTS:

A total of 622 patients were included 287 (46%) had CRRT reinstituted and 335 (54%) were successfully liberated. After adjusting for sepsis at admission and illness severity parameters, several factors were associated with successful liberation, including higher VIS (vasoactive-inotropic score) at CRRT initiation (odds ratio [OR] 1.35 [1.12-1.63]), higher PELOD-2 (pediatric logistic organ dysfunction-2) score at CRRT initiation (OR 1.71 [1.24-2.35]), higher urine output prior to CRRT initiation (OR 1.15 [1.001-1.32]), and shorter CRRT duration (OR 0.19 [0.12-0.28]).

CONCLUSIONS:

Inability to liberate from CRRT was common in this multinational retrospective study. Modifiable and non-modifiable factors were associated with successful liberation. These results may inform the design of future clinical trials to optimize likelihood of CRRT liberation success.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Sistema de Registros / Injúria Renal Aguda / Terapia de Substituição Renal Contínua Limite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male / Newborn Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Sistema de Registros / Injúria Renal Aguda / Terapia de Substituição Renal Contínua Limite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male / Newborn Idioma: En Ano de publicação: 2024 Tipo de documento: Article