Association of continuous kidney replacement therapy timing and mortality in critically ill children.
Background: Acute kidney injury (AKI) is a common complication of critical illness and associated with high morbidity and mortality. Optimal timing of continuous kidney replacement therapy (CKRT) in children is unknown. We aimed to measure the association between timing of initiation and mortality....
| Publicado en: | Pediatric Nephrology Vol. 39; no. 7; pp. 2217 - 2227 |
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| Autores principales: | , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Springer Nature
Jul2024
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=177623359&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 177623359 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0931041X EF1 jtl: Pediatric Nephrology issn: 0931041X maglogo: N pubinfo: dt: Jul2024 vid: 39 iid: 7 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 177623359 175593186 177623359 177623359 10.1007/s00467-024-06320-w 177623359 ppf: 2217 ppct: 10 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Association of continuous kidney replacement therapy timing and mortality in critically ill children. aug: au: Banigan, Maureen A. Keim, Garrett Traynor, Danielle Yehya, Nadir Lindell, Robert B. Fitzgerald, Julie C. affil: Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA sug: subj: Kidney Failure, Acute Therapy Continuous Renal Replacement Therapy Kidney Failure, Acute Mortality Critical Illness Mortality Pediatric Care Treatment Outcomes Human Male Child, Preschool Child Adolescence Critically Ill Patients Retrospective Design Prospective Studies Intensive Care Units, Pediatric Descriptive Statistics Comparative Studies Odds Ratio Confidence Intervals Length of Stay Critical Care Hospital Mortality Critical Illness Therapy Hypervolemia Therapy Child, Preschool: 2-5 years Child: 6-12 years Adolescent: 13-18 years Male ab: Background: Acute kidney injury (AKI) is a common complication of critical illness and associated with high morbidity and mortality. Optimal timing of continuous kidney replacement therapy (CKRT) in children is unknown. We aimed to measure the association between timing of initiation and mortality. Methods: This is a single-center retrospective cohort study of pediatric patients receiving CKRT from 2013 to 2019. The primary exposure, time to CKRT initiation, was measured from onset of stage 3 AKI during hospitalization (defined using Kidney Disease: Improving Global Outcomes creatinine and urine output criteria) and analyzed as both a continuous and categorical variable. The primary outcome was ICU mortality. Results: Ninety-nine patients met criteria for analysis. Overall mortality was 39% (39/99). Median time from stage 3 AKI onset to CKRT initiation was 1.5 days in survivors and 5.5 days in nonsurvivors (p < 0.001). In multivariable analysis, increased time to CKRT initiation was independently associated with mortality [OR 1.02 per hour (95% CI 1.01–1.04), p < 0.001]. Longer time to CKRT initiation was associated with higher odds of mortality in ascending time intervals. Patients started on CKRT > 2 days compared to < 2 days after stage 3 AKI onset had higher mortality (65% vs. 5%, p < 0.001), longer median ICU length of stay (25 vs. 12 d, p < 0.001), longer median CKRT duration (11 vs. 5 d, p < 0.001), and fewer AKI-free days (0 vs. 14 d, p < 0.001). Conclusions: Longer time to initiation of CKRT after development of severe AKI is independently associated with mortality. Consideration of early CKRT in this high-risk population may be a strategy to reduce mortality and improve recovery of kidney function. However, there remains significant heterogeneity in the definition of early versus late initiation and the optimal timing of CKRT remains unknown. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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