Characteristics and Outcomes of Children and Young Adults with Sepsis Requiring Continuous Renal Replacement Therapy: A Comparative Analysis from the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK)∗

Natalja L. Stanski, Katja M. Gist, Denise Hasson, Erin K. Stenson, Jang Dong Seo, Nicholas J. Ollberding, Melissa Muff-Luett, Gerard Cortina, Rashid Alobaidi, Emily See, Ahmad Kaddourah, Dana Y. Fuhrman, Emily Ahern, Ayse Akcan Arikan, Issa Alhamoud, Pilar Anton-Martin, Shanthi S. Balani, Matthew Barhight, Abby Basalely, Amee M. BigelowGabriella Bottari, Andrea Cappoli, Eileen A. Ciccia, Michaela Collins, Denise Colosimo, Mihaela A. Damian, Sara De La Mata Navazo, Gabrielle Deabreu, Akash Deep, Kathy L. Ding, Kristin J. Dolan, Sarah N. Fernandez Lafever, Ben Gelbart, Stephen M. Gorga, Francesco Guzzi, Isabella Guzzo, Taiki Haga, Elizabeth Harvey, Denise C. Hasson, Taylor Hill-Horowitz, Haleigh Inthavong, Catherine Joseph, Aadil Kakajiwala, Aaron D. Kessel, Sarah Korn, Kelli A. Krallman, David M. Kwiatkowski, Jasmine Lee, Laurance Lequier, Tina Madani Kia, Kenneth E. Mah, Eleonora Marinari, Susan D. Martin, Shina Menon, Tahagod H. Mohamed, Catherine Morgan, Theresa A. Mottes, Melissa A. Muff-Luett, Siva Namachivayam, Tara M. Neumayr, Jennifer Nhan Md, Abigail O'Rourke, Matthew G. Pinto, Dua Qutob, Valeria Raggi, Stephanie Reynaud, Zaccaria Ricci, Zachary A. Rumlow, María J. Santiago Lozano, David T. Selewski, Carmela Serpe, Alyssa Serratore, Ananya Shah, Weiwen V. Shih, H. Stella Shin, Cara L. Slagle, Sonia Solomon, Danielle E. Soranno, Rachana Srivastava, Michelle C. Starr, Amy E. Strong, Susan A. Taylor, Sameer V. Thadani, Amanda M. Uber, Brynna Van Wyk, Tennille N. Webb, Huaiyu Zang, Emily E. Zangla, Michael Zappitelli, T. Christine E. Alvarez, Elizabeth Bixler, Erica Blender Brown, Cheryl L. Brown, Ambra Burrell, Anwesh Dash, Jennifer L. Ehrlich, Simrandeep Farma, Kim Gahring, Barbara Gales, Madison R. Hilgenkamp, Sonal Jain, Kate Kanwar, Jennifer Lusk, Christopher J. Meyer, Katherine Plomaritas, Joshua Porter, Jessica Potts, Alyssa Serratore, Elizabeth Schneider, Vidushi Sinha, P. J. Strack, Sue Taylor, Katherine Twombley, Brynna Van Wyk, Samantha Wallace, Janet Wang, Megan Woods, Marcia Zinger, Alison Zong

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

OBJECTIVES: Pediatric sepsis-associated acute kidney injury (AKI) often requires continuous renal replacement therapy (CRRT), but limited data exist regarding patient characteristics and outcomes. We aimed to describe these features, including the impact of possible dialytrauma (i.e., vasoactive requirement, negative fluid balance) on outcomes, and contrast them to nonseptic patients in an international cohort of children and young adults receiving CRRT. DESIGN: A secondary analysis of Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK), an international, multicenter, retrospective study. SETTING: Neonatal, cardiac and PICUs at 34 centers in nine countries from January 1, 2015, to December 31, 2021. PATIENTS: Patients 0-25 years old requiring CRRT for AKI and/or fluid overload. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 1016 patients, 446 (44%) had sepsis at CRRT initiation and 650 (64%) experienced Major Adverse Kidney Events at 90 days (MAKE-90) (defined as a composite of death, renal replacement therapy [RRT] dependence, or > 25% decline in estimated glomerular filtration rate from baseline at 90 d from CRRT initiation). Septic patients were less likely to liberate from CRRT by 28 days (30% vs. 38%; p < 0.001) and had higher rates of MAKE-90 (70% vs. 61%; p = 0.002) and higher mortality (47% vs. 31%; p < 0.001) than nonseptic patients; however, septic survivors were less likely to be RRT dependent at 90 days (10% vs. 18%; p = 0.011). On multivariable regression, pre-CRRT vasoactive requirement, time to negative fluid balance, and median daily fluid balance over the first week of CRRT were not associated with MAKE-90; however, increasing duration of vasoactive requirement was independently associated with increased odds of MAKE-90 (adjusted OR [aOR], 1.16; 95% CI, 1.05-1.28) and mortality (aOR, 1.20; 95% CI, 1.1-1.32) for each additional day of support. CONCLUSIONS: Septic children requiring CRRT have different clinical characteristics and outcomes compared with those without sepsis, including higher rates of mortality and MAKE-90. Increasing duration of vasoactive support during the first week of CRRT, a surrogate of potential dialytrauma, appears to be associated with these outcomes.

Original languageEnglish
Pages (from-to)1686-1699
Number of pages14
JournalCritical care medicine
Volume52
Issue number11
DOIs
StatePublished - Nov 1 2024

Keywords

  • acute kidney injury
  • continuous renal replacement therapy
  • fluid overload
  • pediatrics
  • sepsis

Fingerprint

Dive into the research topics of 'Characteristics and Outcomes of Children and Young Adults with Sepsis Requiring Continuous Renal Replacement Therapy: A Comparative Analysis from the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK)∗'. Together they form a unique fingerprint.

Cite this