256 - Risk Factors for Adverse Short-Term and Long-Term Outcomes in Children With Severe AKI Requiring CRRT

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 256
Publication Number: 256.25

Jeanne Frisby-Zedan, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Matthew Barhight, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Wenya Chen, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Mahima Keswani, Ann and Robert H. Lurie Childrens Hospital of Chicago; Northwestern Medicine, Chicago, IL, United States

Presenting Author(s)

Jeanne Frisby-Zedan, MD (she/her/hers)

Pediatric Nephrology Fellow
Ann & Robert H. Lurie Children's Hospital of Chicago
Ann and Robert H Lurie Children's Hospital of Chicago
Chicago, Illinois, United States

Background: Continuous renal replacement therapy (CRRT) is commonly used to treat severe acute kidney injury (AKI) in critically ill children. Little is known regarding the risk factors that contribute to adverse outcomes in this population.

Objective: To identify the incidence of and risk factors for prolonged hospital length of stay (LOS), intensive care unit (ICU) LOS, ventilator time, and in-hospital mortality, as well as adverse renal sequelae and death following hospital discharge.

Design/Methods:

This single-center, retrospective cohort study, evaluated the demographic and in-hospital risk factors for the short-term and long-term adverse outcomes of patients ages 0-18 years who received CRRT in 2011-2020. Patients with pre-existing chronic kidney disease (CKD) were excluded. The long-term outcomes analysis also excluded those who died prior to discharge or had lack of follow-up data.

Results: The short-term outcome analysis included 217 patients. Median age on admission was 5 years (IQR 0.3-13.4). Median hospital LOS was 42.7 days (IQR 20.2-82.0), ICU LOS was 26.9 days (IQR 11.6-66.5), and ventilator time was 21.0 days (IQR 7.9-46.4). The in-hospital mortality of the cohort was 47%. Multivariable regression revealed admit eGFR, CRRT duration, CRRT instances, blood product transfusions/day on CRRT, % fluid balance on CRRT initiation, and max vasoactive-inotrope score on day of CRRT initiation significantly predicted hospital LOS. Admit eGFR, CRRT duration, CRRT instances, blood product transfusions/day on CRRT, and % fluid balance on CRRT initiation significantly predicted ICU LOS. Admission diagnosis, eGFR at CRRT initiation, CRRT duration, CRRT instances, and % fluid balance significantly predicted ventilator time. Baseline eGFR, max vasoactive-inotrope score on day of CRRT initiation, blood product transfusions/day on CRRT, and % fluid balance on CRRT initiation significantly predicted in-hospital mortality.

The long-term outcome analysis included 98 patients. Median follow-up time was 3.6 years (IQR 1.6-5.1). 16.3% of patients died after hospital discharge, 45.9% had CKD at follow-up, and 19.4% were at-risk for CKD at follow-up. In multivariable regression, risk factors for death were older age on admission and higher urine output 24 hours prior to CRRT initiation. In univariate analysis, ICU LOS was associated with at-risk for CKD and CKD, but was not significant in multivariate analysis.

Conclusion(s): Several in-hospital risk factors contribute to adverse short-term outcomes and death following hospital discharge. Further analyses are needed to identify risk factors for development of CKD.