Risk factors for mortality in critically ill pediatric patients receiving continuous renal replacement therapy

Abstract

Background: Continuous renal replacement therapy is administered increasingly often in pediatric cases of acute kidney injury. However, the mortality rate remains quite high in these patients. Therefore, this study aimed to investigate the risk factors for mortality in critically ill pediatric patients receiving continuous renal replacement therapy. Methods: A retrospective review was conducted on 96 patients who were admitted to a pediatric intensive care unit and underwent continuous renal replacement therapy from January 2013 to December 2022. Results: Of the 96 patients, 47 survived and 49 died, resulting in a mortality rate of 51%. Multivariate analysis showed that each additional vasoactive inotropic agent yielded an odds ratio (OR) of 5.233 (95% confidence interval [CI], 1.804–15.176) for mortality ( p =0.002). Additionally, higher risks of mortality were found for each increase of 1 mmol/L in the lactate level (OR, 1.076; 95% CI, 1.023–1.131; p =0.004) and each 1-day increase in the duration of continuous renal replacement therapy (OR, 1.043; 95% CI, 1.004– 1.084; p =0.030). Conclusion: An increased number of vasoactive inotropic agents, higher lactate levels, and a longer duration of continuous renal replacement therapy were associated with an increased risk of mortality. The management of hypotension and therapeutic interventions for high lactate levels are expected to shorten the duration of continuous renal replacement therapy, thereby reducing the risk of mortality