Patterns of Multiple Organ Dysfunction and Renal Recovery in Critically Ill Children and Young Adults Receiving Continuous Renal Replacement Therapy

Sameer Thadani, MD; Dana Fuhrman, DO, MS; Claire Hanson, MD; Hyun Jung Park, PhD; Joseph Angelo, MD; Poyyapakkam Srivaths, MD; Katri Typpo, MD, MPH; Michael J. Bell, MD; Katja M. Gist, DO, MSc; Joseph Carcillo, MD; Ayse Akcan-Arikan, MD

doi:10.1097/CCE.0000000000001084

Critical Care Explorations (May 2024)

Patterns of Multiple Organ Dysfunction and Renal Recovery in Critically Ill Children and Young Adults Receiving Continuous Renal Replacement Therapy

Sameer Thadani, MD,
Dana Fuhrman, DO, MS,
Claire Hanson, MD,
Hyun Jung Park, PhD,
Joseph Angelo, MD,
Poyyapakkam Srivaths, MD,
Katri Typpo, MD, MPH,
Michael J. Bell, MD,
Katja M. Gist, DO, MSc,
Joseph Carcillo, MD,
Ayse Akcan-Arikan, MD

Affiliations

Sameer Thadani, MD: 1 Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Dana Fuhrman, DO, MS: 3 Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
Claire Hanson, MD: 4 Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA.
Hyun Jung Park, PhD: 6 Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, PA.
Joseph Angelo, MD: 2 Division of Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Poyyapakkam Srivaths, MD: 2 Division of Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Katri Typpo, MD, MPH: 1 Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Michael J. Bell, MD: 7 Department of Critical Care Medicine, Children’s National Hospital, Washington, DC.
Katja M. Gist, DO, MSc: 8 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.
Joseph Carcillo, MD: 3 Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
Ayse Akcan-Arikan, MD: 1 Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX.

DOI: https://doi.org/10.1097/CCE.0000000000001084
Journal volume & issue: Vol. 6, no. 5
p. e1084

Abstract

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OBJECTIVES:. Acute kidney injury requiring dialysis (AKI-D) commonly occurs in the setting of multiple organ dysfunction syndrome (MODS). Continuous renal replacement therapy (CRRT) is the modality of choice for AKI-D. Mid-term outcomes of pediatric AKI-D supported with CRRT are unknown. We aimed to describe the pattern and impact of organ dysfunction on renal outcomes in critically ill children and young adults with AKI-D. DESIGN:. Retrospective cohort. SETTING:. Two large quarternary care pediatric hospitals. PATIENTS:. Patients 26 y old or younger who received CRRT from 2014 to 2020, excluding patients with chronic kidney disease. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Organ dysfunction was assessed using the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score. MODS was defined as greater than or equal to two organ dysfunctions. The primary outcome was major adverse kidney events at 30 days (MAKE30) (decrease in estimated glomerular filtration rate greater than or equal to 25% from baseline, need for renal replacement therapy, and death). Three hundred seventy-three patients, 50% female, with a median age of 84 mo (interquartile range [IQR] 16–172) were analyzed. PELOD-2 increased from 6 (IQR 3–9) to 9 (IQR 7–12) between ICU admission and CRRT initiation. Ninety-seven percent of patients developed MODS at CRRT start and 266 patients (71%) had MAKE30. Acute kidney injury (adjusted odds ratio [aOR] 3.55 [IQR 2.13–5.90]), neurologic (aOR 2.07 [IQR 1.15–3.74]), hematologic/oncologic dysfunction (aOR 2.27 [IQR 1.32–3.91]) at CRRT start, and progressive MODS (aOR 1.11 [IQR 1.03–1.19]) were independently associated with MAKE30. CONCLUSIONS:. Ninety percent of critically ill children and young adults with AKI-D develop MODS by the start of CRRT. Lack of renal recovery is associated with specific extrarenal organ dysfunction and progressive multiple organ dysfunction. Currently available extrarenal organ support strategies, such as therapeutic plasma exchange lung-protective ventilation, and other modifiable risk factors, should be incorporated into clinical trial design when investigating renal recovery.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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