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IV fluids reduced risk for kidney failure in children with hemolytic uremic syndrome

Hickey CA. Arch Pediatr Adolesc Med. 2011;doi:10.1001/archpediatrics.2011.152.

The administering of intravenous fluids during the first 4 days of diarrhea onset is associated with a reduced risk for renal failure among children at risk for hemolytic uremic syndrome, according to new study results.

Christina A. Hickey, MD, of Washington University School of Medicine and St. Louis Children’s Hospital, and colleagues conducted a prospective, observational cohort study at 11 pediatric hospitals in the United States and Scotland. Investigators identified 50 patients aged younger than 18 years from across the United States and in Glasgow, Scotland, who had a post-diarrheal illness that met the case definition of hemolytic uremic syndrome (HUS). Results of this study were released early because of its important public health implications. More than 3,000 cases of enterohemorrhagic Escherichia coli infections and more than 900 cases of HUS have been reported in 16 countries in Europe and North America since the outbreak began in Germany in May, according to a press release about the study.

The overall oligoanuric rate of the 50 children in the study was 68% vs. 84% among those who received no IV fluids in the first 4 days of illness. Results of a multivariate analysis showed that those children who developed oligoanuric renal failure had received less volume of IV fluids and less sodium before developing HUS than patients with non-oligoanuric HUS. Those who received no IV fluids in the first 4 days of illness were 1.6 times more likely to have oligoanuric HUS.

The researchers said the median total volume of fluids (0.05 L/m²) and sodium (7.8 mEq/m²) given to patients in the first 4 days of illness in the current study were 1 to 2 orders of magnitude lower than in the predecessor study (2.5 L/m² and 201 mEq/m², respectively). However, a beneficial effect of this intervention was still identified.

“In summary, IV volume expansion early in illness was associated with better renal outcome during HUS in this second, and independent, systematic cohort study of pre-HUS clinical events and variables,” the researchers wrote. “IV volume expansion is an underused intervention that could decrease the frequency of oligoanuric renal failure in patients at risk of HUS.”

Disclosure: This study was supported by the Doris Duke Clinical Research Fellowship. The researchers report no relevant financial disclosures.

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