Timing of continuous renal replacement therapy and mortality in critically ill children

Vinai Modem, Marita Thompson, Diane Gollhofer, Archana V. Dhar, Raymond Quigley

Research output: Contribution to journalArticle

47 Scopus citations

Abstract

Objectives: Acute kidney injury and fluid overload frequently necessitate initiation of continuous renal replacement therapy in critically ill patients admitted to the ICU. In this study, our primary objective was to determine the effect of timing of initiation of continuous renal replacement therapy on ICU mortality in children requiring renal support for management of acute kidney injury and/or fluid overload. Design: Retrospective cohort study. Setting: Tertiary level, multidisciplinary PICU. Patients: Children who received continuous renal replacement therapy for management of acute kidney injury and/or fluid overload from January 2000 through July 2009 were included in the study. Patients requiring extracorporeal life support and patients initiated on continuous renal replacement therapy for indications other than acute kidney injury and/or fluid overload were excluded. Interventions: None. Measurements and Main Results: Timing of initiation was defined chronologically as time from ICU admission to continuous renal replacement therapy initiation. Three hundred eighty treatments were performed during the study period, of which 190 were eligible and included in the study. Overall ICU mortality was 47% among the study population. Median timing of initiation was higher among nonsurvivors compared with survivors (3.4 vs 2.0 d, p = 0.001). Multivariable logistic regression analysis identified timing of initiation as an independent predictor of mortality with an adjusted odds ratio of 1.05 (95% CI, 1.01, 1.11). Fluid overload, indication for continuous renal replacement therapy initiation, severity of illness at ICU admission, and active oncologic diagnosis were the other independent predictors of mortality that were identified in the final regression model. In the survival analysis, late initiators (> 5 d) had higher mortality than early initiators (≤ 5 d) with a hazard ratio of 1.56 (95% CI, 1.02, 2.37). Conclusions: Earlier initiation of continuous renal replacement therapy was associated with lower mortality in this cohort of critically ill children. Future studies should focus on early identification of such children who may benefit from early continuous renal replacement therapy initiation.

Original languageEnglish (US)
Pages (from-to)943-953
Number of pages11
JournalCritical care medicine
Volume42
Issue number4
DOIs
StatePublished - Apr 2014

Keywords

  • acute kidney injury
  • children
  • continuous renal replacement therapy
  • critically ill
  • fluid overload
  • mortality

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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