Objectives: 

Paralleling improved outcomes in critically ill patients, survival for pediatric acute kidney injury has improved. Continuous renal replacement therapy is the preferred modality to optimize fluid and electrolyte management as well as nutritional support for children developing acute kidney injury in the PICU. However, some patients remain too fragile for transition to intermittent renal replacement therapies and require continuous renal replacement therapy for a prolonged period. Characteristics of this cohort and factors impacting outcomes are not well known. We aimed to describe the characteristics of pediatric patients requiring prolonged continuous renal replacement therapy and evaluate the factors impacting hospital survival.

Design: 

Retrospective chart review.

Setting: 

Tertiary PICU.

Patients: 

Children requiring prolonged continuous renal replacement therapy. Prolonged continuous renal replacement therapy was defined as continuous renal replacement therapy dependence greater than or equal to 28 days. Primary outcome was hospital mortality.

Interventions: 

None.

Measurements and Main Results: 

From 2013 to 2016, 344 patients received continuous renal replacement therapy, 36 (10%) received continuous renal replacement therapy for greater than or equal to 28 days. Seventeen patients (47%) were female. Overall mortality was 44% (16/36); 69% (11/16) of nonsurvivors died of sepsis. Pediatric Logistic Organ Dysfunction score was significantly higher in nonsurvivors. Mortality rate was significantly higher in patients who were neutropenic at continuous renal replacement therapy start. Neutropenia (defined as absolute neutrophil count < 1,500/mm³) at continuous renal replacement therapy start was the only independent predictor of mortality. One in four survivors did not recover renal function and remained dialysis dependent.

Conclusions: 

Prolonged continuous renal replacement therapy patients are at high risk of nonrecovery of renal function and require close monitoring. The majority of nonsurvivors in the study group died from sepsis. Neutropenia at continuous renal replacement therapy initiation was associated with increased risk of mortality. Progression of underlying disease process could explain the higher death rate in patients with neutropenia; however, inadequate treatment of infectious complications could be another explanation to explore further in future studies.

中文翻译：

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重症儿科患者长期连续肾脏替代治疗的特征和临床结果。

目标： 

与危重病人的预后相比，小儿急性肾损伤的生存期得到了改善。连续肾脏替代疗法是优化PICU中发生急性肾脏损伤的儿童的液体和电解质管理以及营养支持的首选方式。但是，有些患者仍然太脆弱，无法过渡到间歇性的肾脏替代疗法，因此需要长时间连续进行肾脏替代疗法。该队列的特征和影响预后的因素尚不清楚。我们旨在描述需要长期连续肾脏替代治疗的儿科患者的特征，并评估影响医院生存的因素。

设计： 

回顾性图表审查。

设置： 

第三重PICU。

耐心： 

儿童需要长时间连续性肾脏替代治疗。长期连续性肾脏替代治疗定义为连续性肾脏替代治疗的依赖性大于或等于28天。主要结局是医院死亡率。

干预措施： 

没有。

测量和主要结果： 

从2013年到2016年，有344例患者接受了连续性肾脏替代治疗，其中36例（10％）接受了连续性肾脏替代治疗超过28天。17名患者（47％）是女性。总死亡率为44％（16/36）；69％（11/16）的非幸存者死于败血症。非幸存者的小儿后勤器官功能障碍评分明显更高。在连续性肾脏替代治疗开始时中性粒细胞减少的患者的死亡率明显更高。连续肾脏替代治疗开始时的中性粒细胞减少症（定义为绝对中性粒细胞计数<1,500 / mm ³）是死亡率的唯一独立预测因子。四分之一的幸存者没有恢复肾功能，仍然依赖于透析。

结论： 

长时间连续进行肾脏替代治疗的患者存在肾功能无法恢复的高风险，需要密切监测。研究组的大多数非幸存者死于败血症。连续肾脏替代治疗开始时的中性粒细胞减少症与死亡风险增加相关。潜在疾病过程的进展可以解释中性粒细胞减少症患者较高的死亡率; 然而，对感染性并发症的治疗不充分可能是进一步研究的另一个解释。