Association of early hyponatremia and the development of acute kidney injury in critically ill children

Formeck, Cassandra L.; Siripong, Nalyn; Joyce, Emily; Ayus, Juan Carlos; Kellum, John A.; Moritz, Michael L.

doi:10.1007/s00467-022-05478-5

Cited by 5 publications

(2 citation statements)

References 53 publications

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“…Data was obtained from the pediatric high-density ICU (Peds HiDenIC) database, which contains data on 8731 patients admitted to the cardiac or pediatric ICUs at UPMC Children's Hospital of Pittsburgh between 2010 and 2014. [20][21][22] Patients were excluded if they had insufficient data to categorize AKI status, were ≥18 years of age, had a history of chronic kidney disease (CKD), kidney transplant, or primary immunodeficiency, community-acquired sepsis (sepsis within the first 48 hours of hospital admission), sepsis prior to ICU admission or invalid date/time information. To have sufficient information to categorize AKI status, children needed a minimum of one serum creatinine measurement, not including the admission serum creatinine measurement, and/or a minimum of 6 hours of recorded urine output during the exposure window.…”

Section: Study Design and Patient Populationmentioning

confidence: 99%

Risk and Timing of De Novo Sepsis in Critically Ill Children after Acute Kidney Injury

et al. 2023

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Background: Acute kidney injury (AKI) is common among critically ill children and is associated with an increased risk for de novo infection, however little is known about the epidemiology and temporal relationship between AKI and AKI-associated infection in this cohort. Methods: We conducted a single-center retrospective cohort study of children admitted to the pediatric and cardiac ICUs at a tertiary pediatric care center. The relationship between non-septic AKI and the development of hospital-acquired sepsis was assessed using Cox proportional-hazards models using AKI as a time-varying covariate. Results: Among the 5695 children included in the study, AKI occurred in 20.2% from ICU admission through 30 days. Hospital-acquired sepsis occurred twice as often among children with AKI compared to those without AKI (10.1% vs. 4.6%) with an adjusted hazard ratio of 1.42 (95% CI 1.12-1.81). Among the 117 children who developed sepsis following AKI, 80.3% developed sepsis within 7 days and 96.6% within 14 days of AKI onset, with a median time from AKI onset to sepsis of 2.6 days (IQR 1.5-4.7). When assessing change in risk over time, the hazard rate for sepsis remained elevated for children with stage 3 AKI compared to children without AKI at 13.5 days following AKI onset, after which the estimation of hazard rates was limited by the number of children remaining in the hospital. Conclusions: AKI is an independent risk factor for de novo sepsis. Critically ill children with stage 3 AKI remain at increased risk for sepsis at 13.5 days following AKI onset.

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Section: Study Design and Patient Populationmentioning

confidence: 99%

Risk and Timing of De Novo Sepsis in Critically Ill Children after Acute Kidney Injury

et al. 2023

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“…Volume status must be carefully assessed when hyponatremia is present. 77 , 129 Sodium needs to be gradually corrected to avoid osmotic demyelination syndrome. Using a CRRT solution with a low sodium concentration has been demonstrated to be safe, feasible, and effective in avoiding rapid hyponatremia correction.…”

Section: Literature Reviewmentioning

confidence: 99%

Nutrition in Critically Ill Children with AKI on Continuous RRT: Consensus Recommendations

Raina,

Suchan,

Sethi

et al. 2023

Kidney360

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Background: Nutrition plays a vital role in the outcome of critically ill children, particularly those with acute kidney injury (AKI). Currently, there are no established guidelines for children with AKI treated with continuous kidney replacement therapy (CKRT). A thorough understanding of the metabolic changes and nutritional challenges in AKI and CKRT is required. Our objective was to create clinical practice points for nutritional assessment and management in critically ill children with AKI receiving CKRT. Methods: PubMed, MEDLINE, Cochrane, and EMBASE databases were searched for articles related to the topic. Expertise of the authors and a consensus of the workgroup were additional sources of data in the article. Available articles on nutrition therapy in pediatric patients receiving CKRT through January 2023. Results: Based on the literature review, the current evidence base was examined by a panel of experts in pediatric nephrology and nutrition. The panel utilized the literature review as well as their expertise to formulate clinical practice points. The modified Delphi method was used to identify and refine clinical practice points. Conclusions: Forty-four clinical practice points are provided on nutrition assessment, determining energy needs, and nutrient intake in children with AKI and on CKRT based on the existing literature and expert opinions of a multidisciplinary panel.

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Correction Rates and Clinical Outcomes in Hospitalized Adults With Severe Hyponatremia

Ayus,

Moritz,

Fuentes

et al. 2024

JAMA Intern Med

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ImportanceHyponatremia treatment guidelines recommend limiting the correction of severe hyponatremia during the first 24 hours to prevent osmotic demyelination syndrome (ODS). Recent evidence suggests that slower rates of correction are associated with increased mortality.ObjectiveTo evaluate the association of sodium correction rates with mortality among hospitalized adults with severe hyponatremia.Data SourcesWe searched MEDLINE, Embase, the Cochrane Library, LILACS, Web of Science, CINAHL, and international congress proceedings for studies published between January 2013 and October 2023.Study SelectionComparative studies assessing rapid (≥8-10 mEq/L per 24 hours) vs slow (&lt;8 or 6-10 mEq/L per 24 hours) and very slow (&lt;4-6 mEq/L per 24 hours) correction of severe hyponatremia (serum sodium &lt;120 mEq/L or &lt;125 mEq/L plus severe symptoms) in hospitalized patients.Data Extraction and SynthesisPairs of reviewers (N.A.F., J.R.M., J.M.A., A.C.) independently reviewed studies, extracted data, and assessed each included study’s risk of bias using ROBINS-I. Cochrane methods, PRISMA reporting guidelines, and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to rate the certainty of evidence were followed. Data were pooled using a random-effects model.Main Outcomes and MeasuresPrimary outcomes were in-hospital and 30-day mortality, and secondary outcomes were hospital length of stay (LOS) and ODS.ResultsSixteen cohort studies involving a total of 11 811 patients with severe hyponatremia were included (mean [SD] age, 68.22 [6.88] years; 56.7% female across 15 studies reporting sex). Moderate-certainty evidence showed that rapid correction was associated with 32 (odds ratio, 0.67; 95% CI, 0.55-0.82) and 221 (odds ratio, 0.29; 95% CI, 0.11-0.79) fewer in-hospital deaths per 1000 treated patients compared with slow and very slow correction, respectively. Low-certainty evidence suggested that rapid correction was associated with 61 (risk ratio, 0.55; 95% CI, 0.45-0.67) and 134 (risk ratio, 0.35; 95% CI, 0.28-0.44) fewer deaths per 1000 treated patients at 30 days and with a reduction in LOS of 1.20 (95% CI, 0.51-1.89) and 3.09 (95% CI, 1.21-4.94) days, compared with slow and very slow correction, respectively. Rapid correction was not associated with a statistically significant increased risk of ODS.Conclusions and RelevanceIn this systematic review and meta-analysis, slow correction and very slow correction of severe hyponatremia were associated with an increased risk of mortality and hospital LOS compared to rapid correction.

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Association of early hyponatremia and the development of acute kidney injury in critically ill children

Cited by 5 publications

References 53 publications

Risk and Timing of De Novo Sepsis in Critically Ill Children after Acute Kidney Injury

Risk and Timing of De Novo Sepsis in Critically Ill Children after Acute Kidney Injury

Nutrition in Critically Ill Children with AKI on Continuous RRT: Consensus Recommendations

Correction Rates and Clinical Outcomes in Hospitalized Adults With Severe Hyponatremia

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