Evaluation of continuous renal replacement therapy and risk factors in the pediatric intensive care unit

Abstract

Acute kidney injury (AKI) is one of the most common causes of increased mortality and morbidity in the pediatric intensive care unit (PICU). Continuous renal replacement therapy (CRRT) is the mainstay treatment for AKI in children as it allows continuous and programmed removal of fluids, which is tolerated better hemodynamically. Defining the risk factors of CRRT related to mortality and morbidity will help improve the outcomes of patients in the PICU. In this study, we aimed to determine the prognostic factors and outcomes of patients who received CRRT. This was a single-center, retrospective study on PICU patients requiring CRRT. Patients with a history of chronic renal failure and PICU stay duration of <24 h and those who died on the 1st day of admission were excluded from the study. A total of 447 patients admitted between October 2016 and March 2018 were included in the study. Children who received CRRT for the management of AKI and/or other nonrenal indications, such as metabolic acidosis, poisoning, electrolyte imbalance, and congenital metabolic diseases, were also included in the study. Fifty patients underwent CRRT. There was a statistically significant relationship between CRRT support and prognostic factors, including age (P = 0.012), inotropic drug usage (P = 0.000), concomitant infection (P = 0.010), blood component transfusion (P = 0.005), pediatric risk of mortality score (P = 0.027), and mortality (P = 0.003). The odds ratio for mortality was 5.396 (95% confidence interval: 1.732-16.809). In conclusion, CRRT is associated with increased morbidity and mortality in the PICU.