{"title":"急性肾损伤重症患儿尿量轨迹和透析独立性：单中心回顾性队列研究，2014-2023。","authors":"Yusuke Tokuda, Kentaro Ide, Junichiro Morota, Eisaku Nashiki, Kentaro Nishi, Mai Miyaji, Masanori Tani, Shotaro Matsumoto, Satoshi Nakagawa","doi":"10.1097/PCC.0000000000003826","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To investigate whether the urine output trajectory is associated with dialysis independence in critically ill children with acute kidney injury (AKI).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>A PICU in Japan.</p><p><strong>Patients: </strong>Children younger than 16 years old who received continuous kidney replacement therapy (CKRT) for AKI between July 1, 2014, and June 30, 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We identified 61 eligible patients, including 16 patients who remained dialysis-dependent 30 days after CKRT initiation. Compared with dialysis-independent patients, dialysis dependence was associated with lower urine output on days 3, 7, 14, and 21 after CKRT initiation. Dialysis independence, when compared with dialysis dependence, was associated with higher median (interquartile range) urine output (mL/kg/hr) at each timepoint (day 3: 0.3 [0.1-1.6] vs. 0.0 [0-0.2]; p = 0.001; day 7: 1.3 [0.4-2.0] vs. 0.0 [0-0.1]; p < 0.001; day 14: 1.8 [1.0-3.5] vs. 0.0 [0-0; p < 0.001]; and day 21: 2.1 [1.1-3.0] vs. 0.0 [0-0]; p < 0.001). The area under the receiver operating characteristic curve (AUROC with 95% CI) for identifying dialysis independence at day 30 after CKRT initiation, based on urine output on day 14, was 0.96 (95% CI, 0.88-1.00). Using the DeLong test, this AUROC was higher than that on day 7 (0.88 [95% CI, 0.77-0.99]; p = 0.009). Also, on day 14, with a pre-test probability of dialysis independence of 71%, the post-test probability increases to 97% when using a test urine output greater than or equal to 0.41 mL/kg/hr. The sensitivity analysis with the exclusion of neonates yielded similar results.</p><p><strong>Conclusions: </strong>In this 2014-2023 cohort of critically ill children with AKI supported with CKRT, using a urine output greater than or equal to 0.41 mL/kg/hr on day 14, CKRT may be an effective diagnostic test of dialysis independence on day 30. Further validation studies are needed.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5000,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Urine Output Trajectories and Dialysis Independence in Critically Ill Children With Acute Kidney Injury: A Single-Center Retrospective Cohort Study, 2014-2023.\",\"authors\":\"Yusuke Tokuda, Kentaro Ide, Junichiro Morota, Eisaku Nashiki, Kentaro Nishi, Mai Miyaji, Masanori Tani, Shotaro Matsumoto, Satoshi Nakagawa\",\"doi\":\"10.1097/PCC.0000000000003826\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To investigate whether the urine output trajectory is associated with dialysis independence in critically ill children with acute kidney injury (AKI).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>A PICU in Japan.</p><p><strong>Patients: </strong>Children younger than 16 years old who received continuous kidney replacement therapy (CKRT) for AKI between July 1, 2014, and June 30, 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We identified 61 eligible patients, including 16 patients who remained dialysis-dependent 30 days after CKRT initiation. Compared with dialysis-independent patients, dialysis dependence was associated with lower urine output on days 3, 7, 14, and 21 after CKRT initiation. Dialysis independence, when compared with dialysis dependence, was associated with higher median (interquartile range) urine output (mL/kg/hr) at each timepoint (day 3: 0.3 [0.1-1.6] vs. 0.0 [0-0.2]; p = 0.001; day 7: 1.3 [0.4-2.0] vs. 0.0 [0-0.1]; p < 0.001; day 14: 1.8 [1.0-3.5] vs. 0.0 [0-0; p < 0.001]; and day 21: 2.1 [1.1-3.0] vs. 0.0 [0-0]; p < 0.001). The area under the receiver operating characteristic curve (AUROC with 95% CI) for identifying dialysis independence at day 30 after CKRT initiation, based on urine output on day 14, was 0.96 (95% CI, 0.88-1.00). Using the DeLong test, this AUROC was higher than that on day 7 (0.88 [95% CI, 0.77-0.99]; p = 0.009). Also, on day 14, with a pre-test probability of dialysis independence of 71%, the post-test probability increases to 97% when using a test urine output greater than or equal to 0.41 mL/kg/hr. The sensitivity analysis with the exclusion of neonates yielded similar results.</p><p><strong>Conclusions: </strong>In this 2014-2023 cohort of critically ill children with AKI supported with CKRT, using a urine output greater than or equal to 0.41 mL/kg/hr on day 14, CKRT may be an effective diagnostic test of dialysis independence on day 30. Further validation studies are needed.</p>\",\"PeriodicalId\":19760,\"journal\":{\"name\":\"Pediatric Critical Care Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-09-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pediatric Critical Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/PCC.0000000000003826\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PCC.0000000000003826","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
目的：探讨急性肾损伤（AKI）危重患儿尿量轨迹是否与透析独立性相关。设计：回顾性队列研究。背景：日本的一个PICU。患者：2014年7月1日至2023年6月30日期间接受持续肾脏替代疗法（CKRT）治疗AKI的16岁以下儿童。干预措施:没有。测量和主要结果：我们确定了61例符合条件的患者，包括16例在CKRT开始30天后仍依赖透析的患者。与不依赖透析的患者相比，透析依赖与CKRT开始后第3、7、14和21天的尿量减少有关。与透析依赖相比，透析独立性与各时间点尿量中位数（四分位数范围）（mL/kg/hr）较高相关（第3天：0.3 [0.1-1.6]vs. 0.0 [0-0.2], p = 0.001；第7天：1.3 [0.4-2.0]vs. 0.0 [0-0.1], p < 0.001；第14天：1.8 [1.0-3.5]vs. 0.0 [0-0, p < 0.001]；第21天：2.1 [1.1-3.0]vs. 0.0 [0-0], p < 0.001）。基于第14天的尿量，在开始CKRT后第30天识别透析独立性的受试者工作特征曲线下面积（AUROC, 95% CI）为0.96 （95% CI, 0.88-1.00）。采用DeLong检验，该AUROC高于第7天（0.88 [95% CI, 0.77-0.99]; p = 0.009）。此外，在第14天，测试前的透析独立性概率为71%，当使用大于或等于0.41 mL/kg/hr的测试尿量时，测试后的概率增加到97%。排除新生儿的敏感性分析得出了类似的结果。结论：在2014-2023年支持CKRT的重症AKI患儿队列中，在第14天使用大于或等于0.41 mL/kg/hr的尿量，CKRT可能是第30天透析独立性的有效诊断试验。需要进一步的验证研究。
Urine Output Trajectories and Dialysis Independence in Critically Ill Children With Acute Kidney Injury: A Single-Center Retrospective Cohort Study, 2014-2023.
Objectives: To investigate whether the urine output trajectory is associated with dialysis independence in critically ill children with acute kidney injury (AKI).
Design: Retrospective cohort study.
Setting: A PICU in Japan.
Patients: Children younger than 16 years old who received continuous kidney replacement therapy (CKRT) for AKI between July 1, 2014, and June 30, 2023.
Interventions: None.
Measurements and main results: We identified 61 eligible patients, including 16 patients who remained dialysis-dependent 30 days after CKRT initiation. Compared with dialysis-independent patients, dialysis dependence was associated with lower urine output on days 3, 7, 14, and 21 after CKRT initiation. Dialysis independence, when compared with dialysis dependence, was associated with higher median (interquartile range) urine output (mL/kg/hr) at each timepoint (day 3: 0.3 [0.1-1.6] vs. 0.0 [0-0.2]; p = 0.001; day 7: 1.3 [0.4-2.0] vs. 0.0 [0-0.1]; p < 0.001; day 14: 1.8 [1.0-3.5] vs. 0.0 [0-0; p < 0.001]; and day 21: 2.1 [1.1-3.0] vs. 0.0 [0-0]; p < 0.001). The area under the receiver operating characteristic curve (AUROC with 95% CI) for identifying dialysis independence at day 30 after CKRT initiation, based on urine output on day 14, was 0.96 (95% CI, 0.88-1.00). Using the DeLong test, this AUROC was higher than that on day 7 (0.88 [95% CI, 0.77-0.99]; p = 0.009). Also, on day 14, with a pre-test probability of dialysis independence of 71%, the post-test probability increases to 97% when using a test urine output greater than or equal to 0.41 mL/kg/hr. The sensitivity analysis with the exclusion of neonates yielded similar results.
Conclusions: In this 2014-2023 cohort of critically ill children with AKI supported with CKRT, using a urine output greater than or equal to 0.41 mL/kg/hr on day 14, CKRT may be an effective diagnostic test of dialysis independence on day 30. Further validation studies are needed.
期刊介绍：
Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
