title: Outcomes of hematopoietic stem cell transplant patients who received continuous renal replacement therapy in a pediatric oncology intensive care unit.
abstract: OBJECTIVE
  To assess the long-term benefits of continuous renal replacement therapy (CRRT) in this patient population and to analyze factors associated with survival. Hematopoietic stem cell transplantation is being utilized as curative therapy for a variety of disorders. However, organ dysfunction is commonly associated with this therapy. Continuous renal replacement therapy (CRRT) is increasingly being used in the treatment of this multiorgan dysfunction.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A free-standing, tertiary care, pediatric oncology hospital.
  
  
  METHODS
  Twenty-nine allogeneic hematopoietic stem cell transplantation patients who underwent 33 courses of CRRT in the intensive care unit between January 2003 and December 2007.
  
  
  METHODS
  Cox proportional hazards regressions models were used to examine the relationship between demographic and clinical variables and length of survival.
  
  
  RESULTS
  The median length of survival post CRRT initiation was 31 days; only one patient survived >6 mos. Factors associated with increased risk of death included: higher bilirubin and blood urea nitrogen levels before and at 48 hrs into CRRT, lower Pao2/Fio2 ratios at 48 hrs of CRRT, and higher C-reactive protein levels, as well as lower absolute neutrophil counts at CRRT end.
  
  
  CONCLUSIONS
  In this single-center study, CRRT was not associated with long-term survival in pediatric allogeneic hematopoietic stem cell transplantation patients. Clinical data exist, both before and during CRRT, that may be associated with length of survival. Lower C-reactive protein levels at CRRT end were associated with longer survival, suggesting that the ability to attenuate inflammation during CRRT may afford a survival advantage. These findings require confirmation in a prospective study.
authors.affiliation: St. Jude Children's Research Hospital, Memphis, TN, USA. surender.rajasekaran@spectrum-health.org
authors.forename: Surender
authors.initials: S
authors.lastname: Rajasekaran
authors.forename: Deborah P
authors.initials: DP
authors.lastname: Jones
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Avent
authors.forename: Michele L
authors.initials: ML
authors.lastname: Shaffer
authors.forename: Lama
authors.initials: L
authors.lastname: Elbahlawan
authors.forename: Nan
authors.initials: N
authors.lastname: Henderson
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Barfield
authors.forename: R Ray
authors.initials: RR
authors.lastname: Morrison
authors.forename: Robert F
authors.initials: RF
authors.lastname: Tamburro
mesh_terms: D000293:Adolescent; D002423:Cause of Death; D002648:Child; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D017582:Renal Replacement Therapy / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome