Continuous kidney replacement therapy outcomes in infants and newborns

Abstract

Background Continuous kidney replacement therapy (CKRT) is utilized in the management of acute kidney injury (AKI). For infants and newborns, it is a challenging procedure. This study aimed to determine the outcomes of CKRT among infants and newborns, given the limited literature available. Methods A retrospective study reviewed charts and the Virtual Performance System in pediatric intensive care unit (PICU) in a tertiary care center in Saudi Arabia. This study included 40 patients (aged 0–1 year) who underwent CKRT from September 2009 to December 2019. Exclusion comprised individuals with a CKRT duration of <24 hours and patients whose primary diagnosis was cardiac in origin. Demographics, nature of diseases, presence of multiorgan failure, modality, and prescriptions of the CKRT were reported. Statistical analysis identified the correlation between the outcome and the mentioned data. Results The median age at intensive care unit (ICU) admission (0–12) was 5 months, and the median weight (2.20–9.70) was 5.45 kg. The most common category was bone marrow transplantation (42.5%), followed by metabolic conditions (20%). The most common modality was continuous venovenous hemodialysis (n = 21; 56.8%). The median blood flow rate (20–100) was 50 mL/min, and the median dialysate flow rate (100–800) was 400 mL/h. The median duration of PICU stay (0.80–139.01) was 16.97 days. Twelve patients (30%) survived, while the majority, 28 (70%), did not survive. The median duration of CKRT was 38.95 h. Most of the patients, 37 out of 40 (92.5%), developed complications during CKRT, with hypothermia (62.5%). The nonsurvived group had a higher weight (6 vs. 4.3 kg, P < 0.01) and was older at ICU admission (6 vs. 3.33 months, P = 0.02). The primary diagnostic category, reason to initiate CKRT, and the presence of multiorgan failure were found to be significantly correlated with the outcome (P < 0.01). Additionally, a significant correlation was found between serum creatinine levels after 3 months of CKRT and age at ICU admission (correlation coefficient 0.47, P = 0.05). Fifty percent of the patients had an overall survival time, from initiating CKRT until the PICU patients’ physical discharge, of 13 days (95% confidence interval: 9–26). Conclusion The overall mortality rate for all causes of CKRT initiation was 70%. However, newborns and infants who underwent CKRT for metabolic causes exhibited an 88% survival rate. Additionally, weight, age at ICU admission, coagulopathies, and the presence of multiorgan failure showed a significant a correlation with the outcome.