title: Dialysis-dependent acute kidney injury in children with end-stage liver disease: prevalence, dialysis modalities and outcome.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a major complication in children with hepatic failure which leads to increased morbidity and mortality. The aim of this study was to provide paediatric data on the prevalence of dialysis-dependent AKI (dAKI), the feasibility and efficacy of dialysis methods and outcome.
  
  
  METHODS
  We conducted a retrospective analysis of 367 children listed for orthotopic liver transplantation (OLT) in our centre during the past decade.
  
  
  RESULTS
  Data on 30 children (15 boys, 15 girls) were compiled for retrospective analysis, and data on dialysis feasibility and efficacy were available for 26 of these. Median age was 3.5 (range 0.4-17.7) years. Median MELD (Model For End-Stage Liver Disease) score was 33. dAKI was caused by hepato-renal syndrome in 16 of the 30 children. Twenty-one patients were treated with continuous veno-venous haemofiltration (CVVH), and nine patients received peritoneal dialysis (PD). Overall mortality was 77%. Mortality within the PD-group was 100 % versus 67% in the CVVH-group (p = 0.039). Urea reduction rate within the first 24 h of treatment was 12.9% in the PD group and 23.5% in the CVVH group (p = 0.019).
  
  
  CONCLUSIONS
  Children with end-stage liver disease have a high risk for dAKI associated with high mortality. CVVH is associated with better efficacy and less mortality than PD.
authors.affiliation: Department of Paediatric Nephrology, Hepatology and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany. kreuzer.martin@mh-hannover.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Kreuzer
authors.affiliation: Department of Paediatric Nephrology, Hepatology and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Gähler
authors.affiliation: Department of Paediatric Nephrology, Hepatology and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: Annette C
authors.initials: AC
authors.lastname: Rakenius
authors.affiliation: Department of Paediatric Nephrology, Hepatology and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: Jenny
authors.initials: J
authors.lastname: Prüfe
authors.affiliation: Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Jack
authors.affiliation: Department of Paediatric Nephrology, Hepatology and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: Eva-Doreen
authors.initials: ED
authors.lastname: Pfister
authors.affiliation: Department of Paediatric Nephrology, Hepatology and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Pape
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D058625:End Stage Liver Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Acute kidney injury; Children; Dialysis-dependent kidney failure; End-stage liver disease; Hepatorenal syndrome