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J Pediatr Intensive Care
DOI: 10.1055/s-0043-1764499
Original Article

Fluid Removal in Children on Continuous Renal Replacement Therapy Improves Organ Dysfunction Score

Sachin D. Tadphale 
1   Division of Pediatric Cardiology & Critical Care Medicine, UTHSC, Memphis, Tennessee, United States
,
Peter M. Luckett 
2   Division of Pediatric Critical Care Medicine, UTSW, Dallas, Texas, United States
,
Raymond P. Quigley 
3   Division of Pediatric Nephrology, UTSW, Dallas, Texas, United States
,
Archana V. Dhar
2   Division of Pediatric Critical Care Medicine, UTSW, Dallas, Texas, United States
,
Diane K. Gollhofer
4   Division of Critical Care Services, Children's Health-Dallas, Dallas, Texas, United States
,
Vinai Modem 
5   Pediatric Intensive Care Unit, Cook Children's Medical Center, Fort Worth, Texas, United States
6   Department of Pediatrics, TCU and UNTHSC School of Medicine, Fort Worth, Texas, United States
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Abstract

The objective is to assess impact of fluid removal on improvement in organ function in children who received continuous renal replacement therapy (CRRT) for management of acute kidney injury and/or fluid overload (FO). A retrospective review of eligible patients admitted to a tertiary level intensive care unit over a 3-year period was performed. Improvement in nonrenal organ function, the primary outcome, was defined as decrease in nonrenal component of Pediatric Logistic Organ Dysfunction (PELOD) score on day 3 of CRRT. The cohort was categorized into Group 1 (improvement) and Group 2 (no improvement or worsening) in nonrenal PELOD score. Multivariable logistic regression analysis was performed to identify independent predictors. A higher PELOD score at CRRT initiation (odds ratio [OR]: 1.11, 95% confidence interval [CI]: 1.05, 1.18, p < 0.001), belonging to infant-age group (OR: 4.53, 95% CI: 4.40, 5.13, p = 0.02) and greater fluid removal during initial 3 days of CRRT (OR: 1.05, 95% CI: 1.01, 1.10, p = 0.01) were associated with an improvement in nonrenal PELOD score at day 3 of CRRT. FO at CRRT initiation (OR: 0.66, 95% CI: 0.46, 0.93, p = 0.02) and having an underlying oncologic diagnosis (OR: 0.28, 95% CI: 0.09, 0.85, p = 0.03) were associated with worsening of nonrenal PELOD score at day 3 of CRRT. Careful consideration of certain modifiable patient and/or fluid removal kinetic factors may have an impact on outcomes.

Keywords

fluid overload - fluid removal - CRRT - organ function recovery - acute kidney injury

Supplementary Material



Publication History

Received: 13 November 2022

Accepted: 18 February 2023

Article published online:
15 March 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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