Children on continuous renal replacement therapy: prognostic factors

W F Hui, Winnie K Y Chan, K W Lee
Hong Kong Medical Journal 2012, 18 (6): 475-81

OBJECTIVES: To identify prognostic factors in children receiving continuous renal replacement therapy.

DESIGN: Historical cohort study.

SETTING: Neonatal and paediatric intensive care unit of a Hong Kong hospital.

PATIENTS: Neonatal or paediatric patients who received continuous renal replacement therapy from January 1998 to December 2008.

RESULTS: In all, 37 patients who received 39 episodes of continuous renal replacement therapy were identified. The male-to-female ratio was 1.5:1. Among the 39 episodes, 15 (39%) were performed on neonates with a mean birth weight of 2.6 (standard deviation, 0.7; range, 0.9-3.7) kg, and 24 (62%) were performed on paediatric patients with a mean age of 7.9 years (standard deviation, 6.4 years; range, 6 months to 18 years). The overall mortality was 41%; in the neonatal and paediatric groups it was 60% and 29%, respectively. There was no significant difference in the mean and maximal ultrafiltration rate in survivors and non-survivors. Multivariate analysis identified the PRISM III score and fluid overload as independent predictors of mortality. Kaplan-Meier survival analysis showed that patients with pre-continuous renal replacement therapy fluid overload of 5.5% or more was associated with reduced survival in the intensive care unit as compared to those having less severe fluid overload (P=0.011). In neonatal patients, there was a higher proportion with multi-organ failure and severe fluid overload.

CONCLUSION: High PRISM III scores and the degree of pre-continuous renal replacement therapy fluid overload were independent predictors of mortality.

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