Trajectory of kidney recovery in pediatric patients requiring continuous kidney replacement therapy for acute kidney injury.

Abstract

Acute kidney injury (AKI) is commonly seen in the PICU and is associated with poor short-term and long-term outcomes, especially in patients who required continuous kidney replacement therapy (CKRT). However, as the trajectory of kidney recovery in these patients remain uncertain, determination of the timing to convert to permanent kidney replacement therapy (KRT) remains a major challenge. We aimed to examine the frequency and timing of kidney recovery in pediatric AKI survivors that required CKRT. We performed a retrospective study of patients under 18years old who received CKRT for AKI in a tertiary-care PICU over 6years. Primary outcomes were the rate of KRT withdrawal due to kidney recovery and KRT-dependent days for those who survived to hospital discharge. Secondary outcomes were all-cause mortality, dialysis dependence, and occurrences of estimated glomerular filtration rate (eGFR) < 90mL/min/1.73m2 and eGFR < 60mL/min/1.73m2 one year after initiation of the index CKRT in survivors. Thirty-nine patients were included. Of the 28 children who survived to hospital discharge, 26 (93%) withdrew from dialysis due to kidney recovery, all within 30days. Twenty-three patients were followed up. One had died, five had an eGFR of 60mL/min/1.73m2 or more but less than 90mL/min/1.73m2, and two had an eGFR < 60mL/min/1.73m2, of which one required peritoneal dialysis. Over 90% of the survivors withdrew CKRT within 30days. However, the frequency of abnormal eGFR one year after initiation of CKRT in survivors exceeded 30% and supports the recommendation of post-AKI follow-up.