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

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 success...

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Published in:Intensive care medicine 2024-06, Vol.50 (6), p.861-872
Main Authors: 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.
Format: Article
Language:English
Subjects:
Adults
Anesthesiology
Children
Clinical trials
Collaboration
Critical Care Medicine
Dialysis
Disorders
Emergency Medicine
Hemodialysis
Intensive
Kidney diseases
Kidneys
Medicine
Medicine & Public Health
Original
Oxygenation
Pain Medicine
Patients
Pediatrics
Pneumology/Respiratory System
Renal replacement therapy
Sepsis
Vasoactive agents
Young adults
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Summary: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.
ISSN:0342-4642
1432-1238
1432-1238
DOI:10.1007/s00134-024-07336-4