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Prolonged Delay in Continuous Renal Replacement Therapy Linked to Adverse Kidney Outcomes in Critically Ill Children

New Study Highlights Importance of Timely Intervention in Pediatric Acute Kidney Injury Cases

Date: January 3, 2024

A recent multinational study involving 969 critically ill children and young adults reveals a concerning association between delayed initiation of Continuous Renal Replacement Therapy (CRRT) and increased risk of major adverse kidney events at 90 days (MAKE-90). The study, conducted using data from the Worldwide Exploration of Renal Replacement Outcome Collaborative in Kidney Disease (WE-ROCK) registry spanning from 2015 to 2021, sheds light on the potential consequences of postponed CRRT initiation in this vulnerable population.

Key Findings:

  • Risk Accumulates with Time: The study, aiming to answer whether a prolonged time to CRRT initiation is linked to worse outcomes, discovered that each one-day delay in CRRT initiation is associated with a 3% higher odds of MAKE-90.
  • MAKE-90 Defined: Major adverse kidney events at 90 days include death, dialysis dependence, or persistent kidney dysfunction (>25% decline in estimated glomerular filtration rate from baseline).
  • Substantial Impact: Of the 969 patients studied, MAKE-90 occurred in 65%, with 58.4% of those cases resulting in mortality. Among survivors, 43.6% experienced persistent kidney dysfunction, and 34.7% of them were dependent on dialysis.

Implications and Recommendations:

  • Increased Risk with Delay: The findings suggest that delaying the initiation of CRRT in critically ill children is associated with a higher risk of adverse outcomes, emphasizing the need for timely intervention.
  • Need for Prospective Studies: The study calls for prospective multicenter studies to further explore the optimal timing for CRRT initiation and its interaction with volume overload to enhance survival and reduce morbidity in pediatric critical care nephrology.
  • Addressing Knowledge Gaps: Despite the attention given to determining the ideal CRRT initiation time, the study highlights significant gaps in knowledge, particularly in the pediatric population, warranting urgent attention.

Conclusion: This comprehensive cohort study underscores the critical importance of timely CRRT initiation in children facing acute kidney injury. The results emphasize the potential life-saving impact of early intervention and set the stage for further research to refine guidelines and practices in pediatric critical care nephrology.

Credit: JAMA Network Open, Katja M. Gist