Acute Kidney Failure

Williams, Debra M.; Sreedhar, Sue; Mickell, John J.; Chan, James C.M.

doi:10.1001/archpedi.156.9.893

Cited by 186 publications

(40 citation statements)

References 34 publications

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“…A number of studies in critically ill children have demonstrated an association of clinical severity-evaluated using the PRISM, PIM, and PELOD scores-and the number of organ failures at the start of CRRT and mortality rates [5,7,8,11,16]. However, none of these studies analyzed the This only applies to patients who survived SD standard deviation, MAP mean arterial pressure, PRISM Pediatric Risk of Mortality score, PIM Pediatric Index of Mortality score, PELOD Pediatric Logistic Organ Dysfunction relationship of these factors with CRRT duration.…”

Section: Discussionmentioning

confidence: 99%

“…Factors associated with a higher mortality rate are clinical severity, underlying disease, and-above all-the hemodynamic status at the start of therapy [4][5][6][7][8][9][10][11]. Some studies have found a higher mortality rate among children with heart disease than among other patients requiring CRRT, particularly in those undergoing cardiac surgery [5,8].…”

Section: Discussionmentioning

confidence: 99%

“…Though renal replacement therapy (RRT) is only required by a small percentage of these patients, the mortality rate in this group is high [4][5][6][7][8][9][10][11]. Continuous renal replacement therapy (CRRT) has become the most widely used renal support modality in critically ill children, as it allows continuous and programmed removal of fluids and is better tolerated hemodynamically [4,12,13].…”

Section: Introductionmentioning

confidence: 99%

“…A number of studies have analyzed prognostic factors in critically ill children who develop renal failure and/or require RRT. Clinical severity, hemodynamic disturbances, number of organ failures, and a positive fluid balance before starting treatment are the main factors determining the prognosis in these patients [4][5][6][7][8][9][10][11]14]. Critically ill children treated using RRT often require relatively prolonged treatment.…”

Section: Introductionmentioning

confidence: 99%

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Clinical course of children requiring prolonged continuous renal replacement therapy

et al. 2009

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A prospective observational study was performed to analyze the clinical course of critically ill children who require continuous renal replacement therapy (CRRT). Variables associated with prolonged CRRT were analyzed. Of the 174 children treated with CRRT, 32 (18.3%) required CRRT for >14 days and 20 (11.5%) for >21 days. Prolonged CRRT was more common in patients with heart disease and those requiring mechanical ventilation, hemodiafiltration, and higher doses of heparin. The same factors were found when patients with CRRT for >14 days and 21 days were studied. Overall mortality rate was 35.6%; it was slightly higher in patients on prolonged CRRT (43.7% with CRRT > 14 days and 45% with CRRT >21 days), though the differences were not statistically significant. We conclude that there were no differences in the pre-CRRT clinical characteristics, severity of illness, and renal function in critically ill children requiring prolonged CRRT. Prolonged CRRT was more frequently required by patients with heart disease and those on mechanical ventilation. Patients with prolonged CRRT required more frequent hemodiafiltration and higher doses of heparin. Mortality was slightly higher in children with longer CRRT, though this difference did not reach statistical significance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical course of children requiring prolonged continuous renal replacement therapy

et al. 2009

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“…While multicenter data do not exist, single center studies from the 1980s and 1990s report hemolytic uremic syndrome (HUS), other primary renal causes, sepsis, and burns as the most prevalent causes leading to pAKI [6,7]. More recent pediatric data [4,8,9,10] reveal a dramatic shift in the epidemiology of pAKI (table 1), with the most common causes being renal ischemia (often after cardiopulmonary bypass surgery [10]), nephrotoxin use, and sepsis; thus, pAKI more often develops in hospitalized children as a result of another systemic illness or its treatment and not from primary kidney disease. pAKI epidemiological study has intensified over recent years, likely as a result of more widespread provision of acute RRT modalities to critically ill children [11].…”

Section: Epidemiology Of Pediatric Akimentioning

confidence: 99%

Acute Kidney Injury in Children and Its Potential Consequences in Adulthood

Goldstein¹

2012

Blood Purif

121

107

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While emerging evidence indicates that the incidence of both acute kidney injury (AKI) and chronic kidney disease (CKD) in children is rising, and the etiologies are dramatically changing, relatively little is currently known regarding the potential for transition from AKI to CKD. In both situations, early intervention can significantly improve the dismal prognosis. Fortunately, recent data have validated a multidimensional AKI classification system for children, and led to the investigation of the chronic kidney sequelae in many pediatric populations with AKI, or at risk for AKI (children with hemolytic uremic syndrome, neonates or those exposed to repeated nephrotoxic medications). The purpose of this article is to review the changing epidemiology of pediatric AKI and its potential effect on the development of CKD in children.

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Associations Between Hydration Status, Intravenous Fluid Administration, and Outcomes of Patients Infected With Shiga Toxin–Producing Escherichia coli

et al. 2017

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IMPORTANCEThe associations between hydration status, intravenous fluid administration, and outcomes of patients infected with Shiga toxin-producing Escherichia coli (STEC) remain unclear.OBJECTIVE To determine the relationship between hydration status, the development and severity of hemolytic uremic syndrome (HUS), and adverse outcomes in STEC-infected individuals.DATA SOURCES MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials via the OvidSP platform, PubMed via the National Library of Medicine, CINAHL Plus with full text, Scopus, Web of Science, ClinicalTrials.gov, reference lists, and gray literature were systematically searched.STUDY SELECTION Two reviewers independently identified studies that included patients with hydration status documentation, proven or presumed STEC infection, and some form of HUS that developed. No language restrictions were applied. DATA EXTRACTION AND SYNTHESISTwo reviewers independently extracted individual study data, including study characteristics, population, and outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale; strength of evidence was adjudicated using the Grading of Recommendations Assessment, Development, and Evaluation method. Meta-analyses were conducted using random-effects models.MAIN OUTCOMES AND MEASURES Development of HUS, complications (ie, oligoanuric renal failure, involvement of the central nervous system, or death), and interventions (ie, renal replacement therapy).RESULTS Eight studies comprising 1511 patients (all children) met eligibility criteria. Unpublished data were provided by the authors of 7 published reports. The median risk-of-bias score was 7.5 (range, 6-9). No studies evaluated the effect of hydration during STEC infections on the risk for HUS. A hematocrit value greater than 23% as a measure of hydration status at presentation with HUS was associated with the development of oligoanuric HUS (OR, 2.38 [95% CI, 1.30-4.35]; I 2 = 2%), renal replacement therapy (OR, 1.90 [95% CI, 1.25-2.90]; I 2 = 17%), and death (OR, 5.13 [95% CI,; I 2 = 55%). Compared with putatively hydrated patients, clinically dehydrated patients had an OR of death of 3.71 (95% CI, 1.25-11.03; I 2 = 0%). Intravenous fluid administration up to the day of HUS diagnosis was associated with a decreased risk of renal replacement therapy (OR, 0.26 [95% CI, 0.11-0.60]).CONCLUSIONS AND RELEVANCE Two predictors of poor outcomes for STEC-infected children were identified: (1) the lack of intravenous fluid administration prior to establishment of HUS and (2) a higher hematocrit value at presentation. These findings point to an association between dehydration and adverse outcomes for children with HUS.

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Acute Kidney Failure

Cited by 186 publications

References 34 publications

Clinical course of children requiring prolonged continuous renal replacement therapy

Clinical course of children requiring prolonged continuous renal replacement therapy

Acute Kidney Injury in Children and Its Potential Consequences in Adulthood

Associations Between Hydration Status, Intravenous Fluid Administration, and Outcomes of Patients Infected With Shiga Toxin–Producing Escherichia coli

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