Impact of early volume expansion on severe long-term kidney sequelae in children with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome.

Abstract

Background: Early fluid management may influence disease severity and long-term kidney outcomes in children with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome (STEC-HUS). We evaluated the association between early volume expansion and severe long-term kidney sequelae.

Methods: We conducted a multicenter retrospective cohort study including children with STEC-HUS and severe acute kidney injury, defined by the need for dialysis for at least 48 h. Kidney outcome at follow-up was classified according to estimated glomerular filtration rate (GFR) as normal kidney function or chronic kidney disease stage 1 versus chronic kidney disease stages 2-5.

Results: A total of 232 children were included. Median age was 2.34 years (interquartile range 1.6-4). At the end of follow-up (median 4.8 years, interquartile range 3.2-6.6), 72 patients (31%) had kidney sequelae corresponding to chronic kidney disease stages 2-5. Early volume expansion was performed in 102 patients (44%). These patients required dialysis for a shorter duration, had higher estimated GFR at follow-up, and less frequently developed chronic kidney disease stages 2-5. Lack of early volume expansion was independently associated with higher odds of kidney sequelae (odds ratio 2.46, 95% confidence interval 1.25-5.03), as was longer dialysis duration (odds ratio 1.10 per day, 95% confidence interval 1.05-1.15). Estimated GFR at follow-up was inversely correlated with dialysis duration; this association was not evident in patients who received early volume expansion but remained significant in those who did not.

Conclusions: Early volume expansion and shorter dialysis duration were associated with long-term improved kidney outcomes.