Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Division of Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Crit Care Explor. 2024 May 6;6(5):e1084. doi: 10.1097/CCE.0000000000001084. eCollection 2024 May 1.
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.
Retrospective cohort.
Two large quarternary care pediatric hospitals.
Patients 26 y old or younger who received CRRT from 2014 to 2020, excluding patients with chronic kidney disease.
None.
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.
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.
急性肾损伤需要透析（AKI-D）在多器官功能障碍综合征（MODS）的情况下很常见。连续性肾脏替代治疗（CRRT）是 AKI-D 的首选治疗方法。接受 CRRT 支持的儿科 AKI-D 的中期结果尚不清楚。我们旨在描述危重病儿童和青少年 AKI-D 患者器官功能障碍对肾脏结局的影响模式。
回顾性队列研究。
两家大型四级护理儿科医院。
2014 年至 2020 年期间接受 CRRT 的年龄在 26 岁或以下的患者，不包括患有慢性肾脏病的患者。
无。
使用儿科 LOGISTIC 器官功能障碍-2（PELOD-2）评分评估器官功能障碍。MODS 定义为大于或等于两个器官功能障碍。主要结局是 30 天的主要不良肾脏事件（MAKE30）（估计肾小球滤过率从基线下降大于或等于 25%，需要肾脏替代治疗和死亡）。373 名患者（50%为女性），中位年龄为 84 个月（IQR 16-172）。PELOD-2 在 ICU 入院和 CRRT 开始时从 6（IQR 3-9）增加到 9（IQR 7-12）。97%的患者在 CRRT 开始时出现 MODS，266 例（71%）出现 MAKE30。急性肾损伤（调整优势比[aOR]3.55[IQR 2.13-5.90]）、神经（aOR 2.07[IQR 1.15-3.74]）、血液/肿瘤功能障碍（aOR 2.27[IQR 1.32-3.91]）在 CRRT 开始时以及进行性 MODS（aOR 1.11[IQR 1.03-1.19]）与 MAKE30 独立相关。
90%的 AKI-D 危重病儿童和青少年在开始 CRRT 时会出现 MODS。肾功能恢复不良与特定的肾外器官功能障碍和进行性多器官功能障碍有关。目前可用的肾外器官支持策略，如治疗性血浆置换肺保护性通气和其他可改变的危险因素，在研究肾功能恢复时应纳入临床试验设计。
