Study: Youths risk major adverse kidney event after continuous kidney replacement therapy
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Key takeaways:
- Overall, 65% of patients experienced major adverse kidney events at 90 days.
- The failure to liberate continuous kidney replacement therapy was among contributing factors.
Major adverse kidney events occurred in a large portion of youths 90 days after undergoing continuous kidney replacement therapy, according to a published cohort study.
“Children, adolescents and young adults with critical illness have a high likelihood of developing AKI and disorders of fluid balance, including pathologic fluid overload,” Dana Y. Fuhrman, DO, MS, of the University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, wrote with colleagues. “While there is significant literature highlighting the short-term morbidity and mortality, the incidence and risk factors associated with modern consensus composite outcomes that go beyond mortality have not been described in youths treated with [continuous kidney replacement therapy] CKRT, to our knowledge.”
Researchers studied 969 patients, aged 0 to 25 years, from The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease, who were treated for AKI or fluid overload. The 2015 to 2021 international, multicenter trial aimed to assess varying incidence and risk factors, such as CKRT liberation patterns, tied to major adverse kidney events 90 days after CKRT in children, adolescents and young adults.
Outcomes were major adverse kidney events at 90 days (MAKE-90), including death or persistent kidney dysfunction, or dialysis dependence or at least 25% decline from baseline eGFR. Data were analyzed in 2023.
Overall, 65% of patients experienced MAKE-90, according to the data. The presence of cardiac comorbidity, longer ICU admission before CKRT initiation and the failure to liberate CKRT were contributing factors to outcomes.
Patients with no prior comorbidities made up the smallest portion with MAKE-90, while patients with cardiac, oncologic or immunologic comorbidities constituted the largest proportions, according to study results.
Researchers found patients who successfully liberated from CKRT within 28 days had lower odds of MAKE-90 compared with patients who did not achieve liberation.
“Our study results support the need for future prospective studies exploring a causative relationship between CKRT parameters and clinically relevant outcomes in children, adolescents and young adults,” Fuhrman and colleagues wrote.
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