Indications and outcomes in children receiving renal replacement therapy in pediatric intensive care.
OBJECTIVE
We aimed to describe patient characteristics, indications for renal replacement therapy (RRT), and outcomes in children requiring RRT. We hypothesized that fluid overload, not classic blood chemistry indications, would be the most frequent reason for RRT initiation.


METHODS
A retrospective cohort study of all patients receiving RRT at a single-center quaternary pediatric intensive care unit between January 2004 and December 2008 was conducted.


RESULTS
Ninety children received RRT. The median age was 7 months (interquartile range, 1-83). Forty-six percent of patients received peritoneal dialysis, and 54% received continuous renal replacement therapy. The median (interquartile range) PRISM-III score was 14 (8-19). Fifty-seven percent had congenital heart disease, and 32% were on extracorporeal life support. The most common clinical condition associated with acute kidney injury was hemodynamic instability (57%; 95% confidence interval [CI], 46-67), followed by multiorgan dysfunction syndrome (17%; 95% CI, 10-26). The most common indication for RRT initiation was fluid overload (77%; 95% CI, 66-86). Seventy-three percent (95% CI, 62-82) of patients survived to hospital discharge.


CONCLUSIONS
Hemodynamic instability and multiorgan dysfunction syndrome are the most common clinical conditions associated with acute kidney injury in our population. In the population studied, the mortality was lower than previously reported in children and much lower than in the adult population.
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Erin D
ED
Boschee
Department of Anesthesiology, University of Alberta, Edmonton, Alberta, Canada.
Dominic A
DA
Cave
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Daniel
D
Garros
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Laurance
L
Lequier
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Donald A
DA
Granoski
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Gonzalo Garcia
GG
Guerra
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. Electronic address: ryerson@ualberta.ca.
Lindsay M
LM
Ryerson
D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D063305:Organ Dysfunction Scores; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome
Acute kidney injury; Pediatric; Peritoneal dialysis; Renal replacement therapy