Patient-centered outcomes in pediatric continuous kidney replacement therapy: new morbidity and worsened functional status in survivors
- 7 July 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Pediatric Nephrology
- Vol. 37 (1), 189-197
- https://doi.org/10.1007/s00467-021-05177-7
Abstract
Background Ongoing measures to improve pediatric continuous kidney replacement therapy (CKRT) have lowered mortality rates, shifting the focus to survivor functional status. While septic acute kidney injury generates new morbidity in pediatric critically ill patients, acquired morbidities and functional status of CKRT population are unknown. We predicted that CKRT survivors are at risk for new morbidity and would have worse functional status at PICU discharge compared to baseline, and aimed to describe associated factors. Methods Retrospective cohort study over 24 months of CKRT patients surviving to PICU discharge in a quaternary children’s hospital. Functional outcome was determined by Functional Status Scale (FSS). Results FSS scores were higher at PICU and hospital discharge compared to baseline. Of 45 CKRT survivors, 31 (69%) had worse FSS score at PICU discharge and 51% had new morbidity (≥3 increase in FSS); majority qualified as moderate to severe disability (FSS ≥10). Four patients (9%) had new tracheostomy, 3 (7%) were ventilator dependent, and 10 (22%) were dialysis dependent. Most (23/45, 51%) required outpatient rehabilitation. Cumulative days on sedation, controlled for illness severity, were independently associated with worse FSS at PICU discharge (aOR 25.18 (3.73, 169.92)). In adjusted analyses, duration of sedation was associated with new morbidity, while neurologic comorbidity, percent fluid overload at CKRT start, and nonrenal comorbidity were associated with moderate to severe disability at PICU discharge when controlled for baseline FSS. Conclusions CKRT survivors, with new morbidity and worse functional outcomes at PICU discharge, are a newly described vulnerable population requiring targeted follow-up. Deliberate decrease of sedation exposure in patients with decreased clearance due to organ dysfunction needs to be studied as a modifiable risk factor.Keywords
This publication has 24 references indexed in Scilit:
- Severe Acute Kidney Injury Is Associated With Increased Risk of Death and New Morbidity After Pediatric Septic Shock*Pediatric Critical Care Medicine, 2020
- Mortality of Critically Ill Children Requiring Continuous Renal Replacement TherapyPediatric Critical Care Medicine, 2019
- Pediatric continuous renal replacement therapy: have practice changes changed outcomes? A large single-center ten-year retrospective evaluationBMC Nephrology, 2018
- MorbidityPediatric Clinics of North America, 2017
- Acute Kidney Injury in Pediatric Severe Sepsis: An Independent Risk Factor for Death and New DisabilityCritical Care Medicine, 2016
- Retrospective Evaluation of Milrinone Pharmacokinetics in Children With Kidney InjuryTherapeutic Drug Monitoring, 2015
- Pharmacokinetics of meropenem in children receiving continuous renal replacement therapy: Validation of clinical trial simulationsThe Journal of Clinical Pharmacology, 2015
- Simultaneous Prediction of New Morbidity, Mortality, and Survival Without New Morbidity From Pediatric Intensive CareCritical Care Medicine, 2015
- Impact of dexmedetomidine on early extubation in pediatric cardiac surgical patientsIntensive Care Medicine, 2011
- Functional Status Scale: New Pediatric Outcome MeasurePEDIATRICS, 2009