Functional outcomes in pediatric patients on renal replacement therapy in a worldwide registry.

Abstract

Background and hypothesis: Mortality rates of children supported with continuous renal replacement therapy (CRRT) have improved, yet morbidity remains high. We aimed to evaluate the functional outcomes of children receiving CRRT using functional status scale (FSS). We hypothesized that children receiving CRRT will have worse FSS compared to their baseline, acquire new morbidity at hospital discharge and 6-and 12-months post discharge, and lack of renal recovery will contribute to worsening functional status.

Methods: This is a retrospective chart review from The Worldwide Exploration of Renal Replacement Outcomes Collaborate in Kidney Disease (WE-ROCK), an international multi-center registry. 28 centers across 5 countries participated in this analysis. Children birth to 25 years, on CRRT for AKI or FO, were included. Patients with underlying kidney disease, on extracorporeal membrane oxygenation, and non-survivors were excluded. FSS was collected at discharge (n = 527), 6 months (n = 387), and 12 months post-discharge (n = 344). The primary outcome was FSS at discharge and 6 months. Secondary outcomes included: new morbidity at discharge and 6 months; FSS at 12 months; and the impact of renal recovery on functional outcomes.

Results: 527 patients had median FSS of 7[6,9] at hospital discharge. 39%(n = 204) had worse FSS. 18%(95/527) acquired a new morbidity at discharge. Predictors of FSS at discharge were baseline FSS(OR 1.30[95% CI 1.11-1.52]), weight(OR 0.99[95% CI 0.98-0.9997]), comorbidities(OR 1.88[95% CI 1.16-3.04]), mechanical ventilation(OR 1.72(95%CI 1.04-2.85]), and sepsis on ICU admission(OR 1.46[95% CI 1.01-2.21]). 387 patients had median FSS score of 6[6,8] at 6 months. 10%(n = 39/387) acquired new morbidity at 6 months. The significant predictors of FSS at 6 months were FSS at discharge(OR 2.36 [95%CI 1.95-2.84]) and presence of comorbidities(OR 1.77[95%CI 1.03-3.06]).

Conclusion: This is the first large, multi-center study evaluating functional outcomes of children on CRRT. Persistent morbidity following discharge emphasizes the importance of comprehensive identification and multidisciplinary follow up to optimize patient outcomes.