Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK)

Menon, Shina; Krallman, Kelli A.; Arikan, Ayse A.; Fuhrman, Dana Y.; Gorga, Stephen M.; Mottes, Theresa; Ollberding, Nicholas; Ricci, Zaccaria; Stanski, Natalja L.; Selewski, David T.; Soranno, Danielle E.; Zappitelli, Michael; Zang, Huaiyu; Gist, Katja M.; Ahern, Emily; Akcan Arikan, Ayse; Alhamoud, Issa; Alobaidi, Rashid; Anton-Martin, Pilar; Balani, Shanthi S.; Barhight, Matthew; Basalely, Abby; Bigelow, Amee M.; Bottari, Gabriella; Cappoli, Andrea; Ciccia, Eileen A.; Collins, Michaela; Colosimo, Denise; Cortina, Gerard; Damian, Mihaela A.; De la Mata Navazo, Sara; DeAbreu, Gabrielle; Deep, Akash; Ding, Kathy L.; Dolan, Kristin J.; Fernandez Lafever, Sarah N.; Fuhrman, Dana Y.; Gelbart, Ben; Gist, Katja M.; Gorga, Stephen M.; Guzzi, Francesco; Guzzo, Isabella; Haga, Taiki; Harvey, Elizabeth; Hasson, Denise C.; Hill-Horowitz, Taylor; Inthavong, Haleigh; Joseph, Catherine; Kaddourah, Ahmad; Kakajiwala, Aadil; Kessel, Aaron D.; Korn, Sarah; Krallman, Kelli A.; Kwiatkowski, David M.; Lee, Jasmine; Lequier, Laurance; Kia, Tina Madani; Mah, Kenneth E.; Marinari, Eleonora; Martin, Susan D.; Menon, Shina; Mohamed, Tahagod H.; Morgan, Catherine; Mottes, Theresa A.; Muff-Luett, Melissa A.; Namachivayam, Siva; Neumayr, Tara M.; Md, Jennifer Nhan; O'Rourke, Abigail; Ollberding, Nicholas J.; Pinto, Matthew G.; Qutob, Dua; Raggi, Valeria; Reynaud, Stephanie; Ricci, Zaccaria; Rumlow, Zachary A.; Santiago Lozano, María J.; See, Emily; Selewski, David T.; Serpe, Carmela; Serratore, Alyssa; Shah, Ananya; Shih, Weiwen V.; Shin, H Stella; Slagle, Cara L.; Solomon, Sonia; Soranno, Danielle E.; Srivastava, Rachana; Stanski, Natalja L.; Starr, Michelle C.; Stenson, Erin K.; Strong, Amy E.; Taylor, Susan A.; Thadani, Sameer V.; Uber, Amanda M.; Van Wyk, Brynna; Webb, Tennille N.; Zang, Huaiyu; Zangla, Emily E.; Zappitelli, Michael

doi:10.1016/j.ekir.2023.05.026

Cited by 15 publications

(8 citation statements)

References 43 publications

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“…Patients with previous dialysis dependence, extracorporeal membrane oxygenation use, or receipt of CKRT for a different indication were excluded. Detailed methods have been previously described …”

Section: Methodsmentioning

confidence: 99%

Major Adverse Kidney Events in Pediatric Continuous Kidney Replacement Therapy

Fuhrman,

Stenson,

Alhamoud

et al. 2024

JAMA Netw Open

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ImportanceContinuous kidney replacement therapy (CKRT) is increasingly used in youths with critical illness, but little is known about longer-term outcomes, such as persistent kidney dysfunction, continued need for dialysis, or death.ObjectiveTo characterize the incidence and risk factors, including liberation patterns, associated with major adverse kidney events 90 days after CKRT initiation (MAKE-90) in children, adolescents, and young adults.Design, Setting, and ParticipantsThis international, multicenter cohort study was conducted among patients aged 0 to 25 years from The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) registry treated with CKRT for acute kidney injury or fluid overload from 2015 to 2021. Exclusion criteria were dialysis dependence, concurrent extracorporeal membrane oxygenation use, or receipt of CKRT for a different indication. Data were analyzed from May 2 to December 14, 2023.ExposurePatient clinical characteristics and CKRT parameters were assessed. CKRT liberation was classified as successful, reinstituted, or not attempted. Successful liberation was defined as the first attempt at CKRT liberation resulting in 72 hours or more without return to dialysis within 28 days of CKRT initiation.Main Outcomes and MeasuresMAKE-90, including death or persistent kidney dysfunction (dialysis dependence or ≥25% decline in estimated glomerular filtration rate from baseline), were assessed.ResultsAmong 969 patients treated with CKRT (529 males [54.6%]; median [IQR] age, 8.8 [1.7-15.0] years), 630 patients (65.0%) developed MAKE-90. On multivariable analysis, cardiac comorbidity (adjusted odds ratio [aOR], 1.60; 95% CI, 1.08-2.37), longer duration of intensive care unit admission before CKRT initiation (aOR for 6 days vs 1 day, 1.07; 95% CI, 1.02-1.13), and liberation pattern were associated with MAKE-90. In this analysis, patients who successfully liberated from CKRT within 28 days had lower odds of MAKE-90 compared with patients in whom liberation was attempted and failed (aOR, 0.32; 95% CI, 0.22-0.48) and patients without a liberation attempt (aOR, 0.02; 95% CI, 0.01-0.04).Conclusions and RelevanceIn this study, MAKE-90 occurred in almost two-thirds of the population and patient-level risk factors associated with MAKE-90 included cardiac comorbidity, time to CKRT initiation, and liberation patterns. These findings highlight the high incidence of adverse outcomes in this population and suggest that future prospective studies are needed to better understand liberation patterns and practices.

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Section: Methodsmentioning

confidence: 99%

Major Adverse Kidney Events in Pediatric Continuous Kidney Replacement Therapy

Fuhrman,

Stenson,

Alhamoud

et al. 2024

JAMA Netw Open

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“…A detailed description of WE-ROCK and its data collection have been previously reported. 20 Baseline kidney function was determined using the serum creatinine in the 90 days prior to admission. For those without a baseline serum creatinine, it was calculated using the bedside Schwartz equation assuming an estimated glomerular filtration rate of 100 mL/min/1.73m 2 .…”

Section: Methodsmentioning

confidence: 99%

“… 9 , 10 , 11 , 12 , 13 , 14 , 15 In children, there is substantial heterogeneity in CRRT practice patterns regarding initiation, dose, fluid removal, and anticoagulation. 16 , 17 , 18 , 19 The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) is a multidisciplinary, international registry formed in 2021 to better understand practice patterns and outcomes of CRRT in a contemporary cohort of children who are critically ill. 20 …”

Section: Introductionmentioning

confidence: 99%

Time to Continuous Renal Replacement Therapy Initiation and 90-Day Major Adverse Kidney Events in Children and Young Adults

Gist,

Menon,

Anton-Martin

et al. 2024

JAMA Netw Open

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ImportanceIn clinical trials, the early or accelerated continuous renal replacement therapy (CRRT) initiation strategy among adults with acute kidney injury or volume overload has not demonstrated a survival benefit. Whether the timing of initiation of CRRT is associated with outcomes among children and young adults is unknown.ObjectiveTo determine whether timing of CRRT initiation, with and without consideration of volume overload (VO; &lt;10% vs ≥10%), is associated with major adverse kidney events at 90 days (MAKE-90).Design, Setting, and ParticipantsThis multinational retrospective cohort study was conducted using data from the Worldwide Exploration of Renal Replacement Outcome Collaborative in Kidney Disease (WE-ROCK) registry from 2015 to 2021. Participants included children and young adults (birth to 25 years) receiving CRRT for acute kidney injury or VO at 32 centers across 7 countries. Statistical analysis was performed from February to July 2023.ExposureThe primary exposure was time to CRRT initiation from intensive care unit admission.Main Outcomes and measuresThe primary outcome was MAKE-90 (death, dialysis dependence, or persistent kidney dysfunction [&gt;25% decline in estimated glomerular filtration rate from baseline]).ResultsData from 996 patients were entered into the registry. After exclusions (n = 27), 969 patients (440 [45.4%] female; 16 (1.9%) American Indian or Alaska Native, 40 (4.7%) Asian or Pacific Islander, 127 (14.9%) Black, 652 (76.4%) White, 18 (2.1%) more than 1 race; median [IQR] patient age, 8.8 [1.7-15.0] years) with data for the primary outcome (MAKE-90) were included. Median (IQR) time to CRRT initiation was 2 (1-6) days. MAKE-90 occurred in 630 patients (65.0%), of which 368 (58.4%) died. Among the 601 patients who survived, 262 (43.6%) had persistent kidney dysfunction. Of patients with persistent dysfunction, 91 (34.7%) were dependent on dialysis. Time to CRRT initiation was approximately 1 day longer among those with MAKE-90 (median [IQR], 3 [1-8] days vs 2 [1-4] days; P = .002). In the generalized propensity score–weighted regression, there were approximately 3% higher odds of MAKE-90 for each 1-day delay in CRRT initiation (odds ratio, 1.03 [95% CI, 1.02-1.04]).Conclusions and RelevanceIn this cohort study of children and young adults receiving CRRT, longer time to CRRT initiation was associated with greater risk of MAKE-90 outcomes, in particular, mortality. These findings suggest that prospective multicenter studies are needed to further delineate the appropriate time to initiate CRRT and the interaction between CRRT initiation timing and VO to continue to improve survival and reduce morbidity in this population.

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“…Nafamostat mesylate was the primary anticoagulant used, with unfractionated heparin also being commonly employed. The frequency of circuit exchange 7), which comprises 32 centers from around the world (13). A modified Delphi approach was used whereby consensus was defined by a greater than or equal to 75% participant response of "sometimes" or "always" in the 63 and 50 items, first and second rounds of a survey, respectively.…”

Section: Japanese Picusmentioning

confidence: 99%

“…A systematic review of the 2012–2022 literature informed two rounds of a survey sent in 2022 to CRRT prescribers participating in the Worldwide Exploration of Renal Outcomes Collaborative in Kidney Diseases (WE-ROCK) collaborative (7), which comprises 32 centers from around the world (13). A modified Delphi approach was used whereby consensus was defined by a greater than or equal to 75% participant response of “sometimes” or “always” in the 63 and 50 items, first and second rounds of a survey, respectively.…”

Section: Surveys Of Crrtmentioning

confidence: 99%

Continuous Renal Replacement Therapy: Current State and Future Directions for Worldwide Practice

Gist,

Fuhrman,

Deep

et al. 2024

Pediatric Critical Care Medicine

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Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK)

Cited by 15 publications

References 43 publications

Major Adverse Kidney Events in Pediatric Continuous Kidney Replacement Therapy

Major Adverse Kidney Events in Pediatric Continuous Kidney Replacement Therapy

Time to Continuous Renal Replacement Therapy Initiation and 90-Day Major Adverse Kidney Events in Children and Young Adults

Continuous Renal Replacement Therapy: Current State and Future Directions for Worldwide Practice

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