Paediatric Intensive care Unit, University Hospitals Leicester NHS Trust, Leicester, United Kingdom.
Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, United Kingdom.
Pediatr Crit Care Med. 2018 Mar;19(3):210-217. doi: 10.1097/PCC.0000000000001431.
Although renal replacement therapy is widely used in critically ill children, there have been few comprehensive population-based studies of its use. This article describes renal replacement therapy use, and associated outcomes, in critically ill children across the United Kingdom in the largest cohort study of this patient group.
A retrospective observational study using prospectively collected data.
Data from the Pediatric Intensive Care Audit Network database which collects data on all children admitted to U.K. PICUs.
Children (< 16 yr) in PICU who received renal replacement therapy between January 1, 2005, and December 31, 2012, were identified.
Individual-level data including age, underlying diagnosis, modality (peritoneal dialysis and continuous extracorporeal techniques [continuous renal replacement therapy]), duration of renal replacement therapy, PICU length of stay, and survival were extracted.
Three-thousand eight-hundred twenty-five of 129,809 PICU admissions (2.9%) received renal replacement therapy in 30 of 33 centers. Volumes of renal replacement therapy varied considerably from 0% to 8.6% of PICU admissions per unit, but volume was not associated with patient survival. Overall survival to PICU discharge (73.8%) was higher than previous reports. Mortality risk was related to age, with lower risk in older children compared with neonates (odds ratio, 0.6; 95% CI, 0.5-0.8) although mortality did not increase over the age of 1 year; mode of renal replacement therapy, with lower risk in peritoneal dialysis than continuous renal replacement therapy methodologies (odds ratio, 0.7; 0.5-0.9); duration of renal replacement therapy (odds ratio, 1.02/d; 95% CI, 1.01-1.04); and primary diagnosis, with the lowest survival in liver disease patients (53.9%).
This study describes current renal replacement therapy use across the United Kingdom and associated outcomes. We describe a number of factors associated with outcome, including age, underlying diagnosis, and renal replacement therapy modality which will need to be factored into future trial design.
尽管肾脏替代疗法在危重症儿童中广泛应用，但对其使用情况进行全面的基于人群的研究甚少。本文描述了英国危重症儿童使用肾脏替代疗法的情况及其相关结局，这是该患者群体最大规模的队列研究。
使用前瞻性收集的数据进行回顾性观察性研究。
数据来自儿科重症监护室网络数据库，该数据库收集了英国所有儿科重症监护病房患儿的资料。
2005 年 1 月 1 日至 2012 年 12 月 31 日期间在儿科重症监护病房接受肾脏替代治疗的<16 岁患儿。
提取了个体水平的数据，包括年龄、基础诊断、方式（腹膜透析和连续体外技术[连续肾脏替代治疗]）、肾脏替代治疗时间、儿科重症监护病房住院时间和生存情况。
在 33 家中心中的 30 家中心中，129809 例儿科重症监护病房入院患者中有 3825 例（2.9%）接受了肾脏替代治疗。肾脏替代治疗的量从每单位儿科重症监护病房入院患者的 0%到 8.6%变化很大，但量与患者生存无关。儿科重症监护病房出院时的总体生存率（73.8%）高于以往报告。死亡风险与年龄相关，与新生儿相比，年龄较大的儿童风险较低（比值比，0.6；95%置信区间，0.5-0.8），尽管 1 岁以上儿童的死亡率并未增加；肾脏替代治疗方式，腹膜透析的风险低于连续肾脏替代治疗方法（比值比，0.7；0.5-0.9）；肾脏替代治疗时间（比值比，1.02/d；95%置信区间，1.01-1.04）；以及主要诊断，肝病患者的生存率最低（53.9%）。
本研究描述了英国目前肾脏替代疗法的使用情况及其相关结局。我们描述了一些与结局相关的因素，包括年龄、基础诊断和肾脏替代治疗方式，这将需要在未来的试验设计中加以考虑。
