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Hemodialysis for children with AKI has increased despite high 30-day mortality risk
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Recently published findings from Canada suggest use of hemodialysis for children hospitalized with acute kidney injury has increased in 2 decades and is associated with a high risk for short-term mortality.
“AKI has been increasingly recognized as an important complication in hospitalized children,” Rahul Chanchlani, MD, of the division of pediatric nephrology at McMaster Children’s Hospital in Ontario, Canada, and colleagues wrote. “AKI is strongly associated with hospital mortality in children, and among those with severe AKI receiving dialysis, hospital mortality is as high as 50% to 70%. Recent data suggest that the incidence of dialysis-receiving AKI has increased among adults over the past 2 decades. However, the trends in the incidence of AKI over time have not been well documented in children.”
To examine the trends in dialysis use and its association with 30-day mortality, researchers conducted a population-based cohort study of 1,394 children aged between 29 days and 18 years who received their first dialysis treatment for AKI between 1996 and 2015.
Researchers found that, while the use of PD declined during the study period, use of continuous kidney replacement therapy and intermittent hemodialysis increased. The incidence of dialysis-receiving AKI was 0.58 per 1,000 person-years in 1996 compared with 0.65 per 1,000 person-years in 2015. Thirty-day mortality rates after receiving dialysis also increased (14% in 1996 vs. 25% in 2009, though this has stabilized to 20% in the past 10 years).
In addition, researchers noted the median age at dialysis initiation among children consistently decreased over time, from 13 years during 1996 to 2001 to 3 years during 2010 to 2015.
“One fifth of children die within 30 days of initiating dialysis for AKI and the short-term mortality after dialysis-receiving AKI has increased significantly over time,” the researchers wrote. “This is the only population-wide study examining the trends in dialysis-receiving AKI among children and represents the largest reported cohort of nonadults with dialysis-receiving AKI. Future research should aim to test strategies that will improve outcomes in this vulnerable population.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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