Department of Nephrology, Monash Children's Hospital, Clayton, VIC, Australia.
Department of Pediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
Pediatr Nephrol. 2024 Feb;39(2):547-557. doi: 10.1007/s00467-023-06095-6. Epub 2023 Aug 9.
Paediatric kidney transplant recipients may be at a particular risk of dehydration due to poor kidney concentrating capacity and illness associated with poor fluid intake or losses. In this population, creatinine rise may be more likely with relatively mild dehydration, which may trigger hospital admission. This study describes hospital admissions in the first 12 months after transplantation with diagnosis of graft dysfunction associated with dehydration due to illness or poor fluid intake. We assess risk factors for these admissions.
Data was extracted from medical records of patients transplanted in two tertiary children hospitals. Following descriptive analysis, multiple failure regression analyses were used to identify factors associated with admission for acute kidney allograft dysfunction associated with dehydration.
Of 92 children, 42% had at least 1 dehydration admission in the 12 months following transplantation. Almost half of the dehydration admissions were due to poor fluid intake, which accounted for 1/5 of all unplanned hospital admissions. Target fluid intake at first discharge of > 100 ml/kg/day was associated with dehydration admissions of all types (hazard ratio (HR) 2.04 (95% CI 1.13-3.68)). Teen age was associated with poor fluid intake dehydration admissions (HR 4.87 (95% CI 1.19-19.86)), which were more frequent in mid-summer. Use of enteric feeding tube, which correlated with age under 4, associated with contributing illness dehydration admissions (HR 2.18 (95% CI 1.08-4.41)).
Dehydration admissions in the 12 months following childhood kidney transplantation are common. Highlighted admission risk factors should prompt further study into optimal fluid intake prescription and hydration advice given to children, teenagers, and their carers following kidney transplantation. Use of an enteric feeding tube may not protect patients from admission with dehydration associated with contributing illness. A highger resolution version of the Graphical abstract is available as Supplementary information.
由于儿童肾脏浓缩能力差，以及与液体摄入不足或丢失相关的疾病，儿科肾移植受者可能特别容易脱水。在该人群中，相对轻度的脱水可能更容易导致肌酐升高，这可能会引发住院治疗。本研究描述了移植后 12 个月内因疾病或液体摄入不足导致的与脱水相关的移植物功能障碍而住院的情况。我们评估了这些入院的危险因素。
从两家三级儿童医院的患者病历中提取数据。在进行描述性分析后，采用多次失效回归分析来确定与因脱水导致急性肾移植功能障碍相关的入院因素。
在 92 名儿童中，42%的儿童在移植后 12 个月内至少有 1 次因脱水而入院。近一半的脱水入院是由于液体摄入不足所致，占所有非计划住院的 1/5。首次出院时的目标液体摄入量>100ml/kg/天与所有类型的脱水入院有关（风险比（HR）2.04（95%可信区间 1.13-3.68））。青少年与液体摄入不足性脱水入院相关（HR 4.87（95%可信区间 1.19-19.86）），夏季中期更为常见。肠内喂养管的使用与<4 岁的年龄相关，与引起疾病的脱水入院相关（HR 2.18（95%可信区间 1.08-4.41））。
儿童肾移植后 12 个月内的脱水入院很常见。突出的入院危险因素应促使进一步研究儿童、青少年及其照顾者在肾移植后最佳液体摄入处方和补液建议。使用肠内喂养管并不能防止因与相关疾病相关的脱水而入院。该研究的补充信息中提供了图形摘要的更高分辨率版本。
