Long-term kidney follow-up after pediatric acute kidney support therapy for children less than 15kg.

Abstract

In small children, acute dialysis (pediatric acute kidney support therapy (paKST)) is increasingly used; however, it is challenging for many reasons. We compared clinical characteristics and predictors of long-term outcomes of patients < 15kg on peritoneal dialysis (PD), hemodialysis (HD), and continuous kidney replacement therapy (CKRT). Patients with history of paKST (CKRT, HD, PD) weighing < 15kg and ≥ 6months of follow-up at Hacettepe University were included. Surviving patients were evaluated at last visit. 109 patients (57 females) were included. Median age at paKST was 10.1months (IQR: 2-27months). In total, 43 (39.4%) patients received HD, 37 (34%) PD, and 29 (26.6%) CKRT. 64 (58.7%) patients died a median 3days (IQR: 2-9.5days) after paKST. Percentages of patients using vasopressor agents, with sepsis, and undergoing mechanical ventilation were lower in those who survived. After mean follow-up of 2.9 ± 2.1years, 34 patients were evaluated at mean age 4.7 ± 2.4years. Median spot urine protein/creatinine was 0.19 (IQR: 0.13-0.37) and 12 patients (35.3%) had non-nephrotic proteinuria. Three patients had estimated glomerular filtration rate (eGFR) < 90mL/min/1.73m2 and 2 (6%) had hyperfiltration. In total 22 patients (64.7%) had ≥ 1 kidney risk factor (elevated blood pressure/hypertension, hyperfiltration, eGFR < 90ml/min/1.73m2, and/or proteinuria) at last visit. Among 28 patients on paKST < 32months, 21 had ≥ 1 risk factor (75%), whereas among 6 patients who had paKST ≥ 32months, one patient had ≥ 1 risk factor (16.7%), (p = 0.014). Patients on paKST who undergo mechanical ventilation and vasopressor treatment should be followed-up more closely. After surviving the acute period, patients on paKST need to be followed-up closely during the chronic stage. A higher resolution version of the Graphical abstract is available as Supplementary information.