14 - Timing of Continuous Kidney Replacement Therapy Initiation and Major Adverse kidney events at 90 days: A retrospective analysis of the WE-ROCK Registry.

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 14
Publication Number: 14.107

Katja M. Gist, Children's Hospital Medical Center (Cincinnati), Cincinnati, OH, United States; Pilar Anton-Martin, Le Bonheur Children's Hospital, Memphis, TN, United States; Amee M. Bigelow, Nationwide Children's Hospital, Columbus, OH, United States; Gerard Cortina, Innsbruck Medical University, Innsbruck, Tirol, Austria; Akash Deep, King’s College Hospital London, London, England, United Kingdom; Ben Gelbart, Royal Children's Hospital, Melbourne, Victoria, Australia; Stephen Gorga, University of Michigan Medical School, Ann Arbor, MI, United States; Isabella Guzzo, Bambino Gesù Children's Hospital, Rome, Lazio, Italy; Kenneth E. Mah, Stanford University School of Medicine, Palo Alto, CA, United States; Sara de la Mata Navazo, Hospital Gregorio Marañon, Madrid, Madrid, Spain; Nicholas Ollberding, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; H Stella Shin, Emory University / Children’s Healthcare of Atlanta, Atlanta, GA, United States; Sameer Thadani, Baylor College of Medicine, Houston, TX, United States; Amanda M. Uber, UNMC, Omaha, NE, United States; Huaiyu Zang, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Michael Zappitelli, The Hospital for Sick Children, Toronto, ON, Canada; David Selewski, Medical University of South Carolina, Mount Pleasant, SC, United States

Presenting Author(s)

Katja M. Gist, DO, MSc (she/her/hers)

Associate Professor of Pediatrics
Children's Hospital Medical Center (Cincinnati)
Cincinnati, Ohio, United States

Background: Acute kidney injury (AKI) and fluid overload (FO) are common in critically ill children. Among adults, early initiation of continuous renal replacement therapy (CRRT) was not associated with a reduction in 90-day mortality.

Objective: Evaluate the association of early (≤48 hours) vs. late CRRT start ( >48 hours) from ICU admission with major adverse kidney events at 90 days (MAKE-90).

Design/Methods:

The WE-ROCK study is an international, multicenter study (32 centers, 7 nations) of patients aged 0-25 years treated with CRRT for AKI or FO. Patients with end stage kidney disease, congenital anomalies of the kidney and urinary tract perceived to require long-term CRRT, concurrent use of extracorporeal membrane oxygenation, and use of peritoneal dialysis prior to CRRT were excluded. The primary outcome was MAKE-90 (defined as dialysis dependence, death, persistent kidney dysfunction >25% above baseline). Secondary outcomes were ICU Length of stay (LOS) and duration of mechanical ventilation (MV). Odds ratio (OR) and 95% confidence intervals (CI) were obtained by logistic regression accounting for nesting of patients within centers via the Huber–White cluster sandwich estimator of variance.

Results:

1000 patients were included. The median time to CRRT initiation in the entire cohort was 2 days (IQR: 1,6 days). CRRT was started >48h in 470 (47%). MAKE-90 occurred in 628 (63%) of which 50% (n=312) had late CRRT start. Admission diagnoses and comorbid conditions were different between groups. %FO at CRRT was greater among those with late CRRT start (p< 0.001) but not MAKE-90. The proportion of patients with late CRRT start was not different between those with and without MAKE-90 (p=0.07). LOS and MV duration were significantly longer among those with late CRRT start (Table1). Later time to CRRT start was associated with a higher adjusted odds of MAKE-90 (interquartile OR=1.08, 95% CI=1.02-1.15) (Table 2). Longer time to CRRT start was associated with an increased probability of developing MAKE-90 (Figure).

Conclusion(s): Late CRRT start was associated with MAKE-90. A randomized comparative effectiveness trial in children is necessary to evaluate whether timing of CRRT start impacts outcomes.