Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy

Goldstein, Stuart L.; Somers, Michael J.; Baum, Michelle A.; Symons, Jordan M.; Brophy, Patrick D.; Blowey, Douglas L.; Bunchman, Timothy E.; Baker, Cheryl; Mottes, Theresa; McAfee, Nancy; Barnett, Joni; Morrison, Gloria; Rogers, Kristine; Fortenberry, James D.

doi:10.1111/j.1523-1755.2005.67121.x

Cited by 468 publications

(351 citation statements)

References 22 publications

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“…The excellent negative predictive value (.90%) of the RAI allows a clinician to reliably rule out AKI outside the window of functional AKI (25) and may afford more freedom of management for the acutely ill patient (i.e., higher volume resuscitation) with fewer concerns about developing the severe fluid overload consistently associated with poor outcomes in critically ill children (35)(36)(37). Our study has several strengths.…”

Section: Discussionmentioning

confidence: 95%

Incorporation of Biomarkers with the Renal Angina Index for Prediction of Severe AKI in Critically Ill Children

Basu

Wang

Wong

et al. 2014

Clinical Journal of the American Society of Nephrology

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137

113

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Background and objectives Novel AKI biomarkers carry variable performance for prediction of AKI in patients with heterogeneous illness. Until utility is demonstrated in critically ill patients outside of the cardiopulmonary bypass population, AKI biomarkers are unlikely to gain widespread implementation. Operationalization of an AKI risk stratification methodology, termed renal angina, was recently reported to enhance prediction at the time of intensive care unit admission for persistent severe AKI. The renal angina index (RAI) was developed to provide the clinical context to direct AKI biomarker testing. This study tested the hypothesis that incorporation of AKI biomarkers in patients fulfilling renal angina improves the prediction of persistent severe AKI.Design, setting, participants, & measurements In a multicenter study of 214 patients admitted to the pediatric intensive care unit with sepsis, the discrimination of plasma neutrophil gelatinase-associated lipocalin (NGAL), matrix metalloproteinase-8 (MMP-8), and neutrophil elastase-2 (Ela-2) were determined individually and in combination with the RAI for severe AKI. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated. Conclusions This study shows that incorporation of AKI biomarkers into the RAI improves discrimination for severe AKI. The RAI optimizes the utility of AKI biomarkers in a heterogeneous, critically ill patient population.

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Section: Discussionmentioning

confidence: 95%

Incorporation of Biomarkers with the Renal Angina Index for Prediction of Severe AKI in Critically Ill Children

Basu

Wang

Wong

et al. 2014

Clinical Journal of the American Society of Nephrology

Self Cite

137

113

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“…Data from the Prospective Pediatric CRRT Registry Group demonstrated again that % fluid overload was associated with mortality, and that survival was improved (76%) if dry weight was attained during CRRT as compared to those who did not attain dry weight (36%). 34 Since the earliest animal studies of sepsis, a soluble myocardial depressant factor has been postulated to exist and is later suggested as removable from the plasma. Hemofiltration in a canine sepsis model reversed left ventricular dysfunction 35 as well as right ventricular dysfunction in porcine sepsis.…”

Section: Indicationsmentioning

confidence: 99%

Renal replacement therapy review

Fleming

2011

Organogenesis

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“…[13][14][15][16] Furthermore, recent attention has been given to the role of fluid overload as a factor associated with increased mortality in patients with AKI. [17][18][19] Many of the factors associated with increased mortality in patients with AKI are likely to be absent in patients with end-stage renal disease (ESRD). For example, ICU patients with ESRD are less likely to be fluid overloaded as volume resuscitation is generally less aggressive in patients with ESRD.…”

Section: Introductionmentioning

confidence: 99%

In Critically Ill Patients Requiring CRRT, AKI Is Associated with Increased Respiratory Failure and Death Versus ESRD

et al. 2011

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Background/aims: To compare outcomes of critically ill patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) versus those with pre-existing end-stage renal disease (ESRD) requiring CRRT to identify factors that contribute to the increased mortality seen in AKI patients. Methods: Retrospective cohort of 257 intensive care unit (ICU) patients who received CRRT. AKI is defined as requiring CRRT with an admission serum creatinine ≤1 mg/dL; ESRD is defined as chronic dialysis dependence. Primary outcome was hospital mortality. Multivariate logistic regression was performed to determine the impact of APACHE II score, intubation, vasopressors, infection, diabetes, hypertension, gender, and race on mortality. Results: Of 257 patients requiring CRRT, 28 had ESRD and 108 had AKI. Hospital mortality was higher in patients with AKI versus ESRD (69% vs. 39%, p = 0.0032). Severity of illness using APACHE II was similar in AKI and ESRD. Patients with AKI were more likely to require mechanical ventilation (89% vs. 57%, p = 0.0003). After multivariate analysis, the requirement for mechanical ventilation was the single factor associated with increased hospital mortality [odds ratio (OR): 3.1]. Conclusions: In ICU patients requiring CRRT, patients with AKI have a higher mortality than patients with ESRD due to an increased need for mechanical ventilation.

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Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy

Abstract: We suggest that after initial resuscitative efforts, an increased emphasis should be placed on early initiation of CRRT and inotropic agent use over fluid administration to maintain acceptable blood pressure.

Cited by 468 publications

References 22 publications

Incorporation of Biomarkers with the Renal Angina Index for Prediction of Severe AKI in Critically Ill Children

Incorporation of Biomarkers with the Renal Angina Index for Prediction of Severe AKI in Critically Ill Children

Renal replacement therapy review

In Critically Ill Patients Requiring CRRT, AKI Is Associated with Increased Respiratory Failure and Death Versus ESRD

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