Epidemiology and Outcome of Critically Ill Pediatric Cancer and Hematopoietic Stem Cell Transplant Patients Requiring Continuous Renal Replacement Therapy: A Retrospective Nationwide Cohort Study.
Acute Kidney Injury
/ mortality
Adolescent
Cardiotonic Agents
/ therapeutic use
Child
Child, Preschool
Cohort Studies
Continuous Renal Replacement Therapy
Creatinine
/ blood
Critical Illness
/ mortality
Female
Hematopoietic Stem Cell Transplantation
Hospital Mortality
Humans
Intensive Care Units, Pediatric
Male
Neoplasms
/ epidemiology
Netherlands
/ epidemiology
Retrospective Studies
Transplant Recipients
Weight Gain
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
pubmed:
30
8
2019
medline:
26
5
2020
entrez:
30
8
2019
Statut:
ppublish
Résumé
Acute kidney injury requiring continuous renal replacement therapy is a serious treatment-related complication in pediatric cancer and hematopoietic stem cell transplant patients. The purpose of this study was to assess epidemiology and outcome of these patients requiring continuous renal replacement therapy in the PICU. A nationwide, multicenter, retrospective, observational study. Eight PICUs of a tertiary care hospitals in the Netherlands. Pediatric cancer and hematopoietic stem cell transplant patients (cancer and noncancer) who received continuous renal replacement therapy from January 2006 to July 2017 in the Netherlands. None. Of 1,927 PICU admissions of pediatric cancer and hematopoietic stem cell transplant patients, 68 of 70 evaluable patients who received continuous renal replacement therapy were included. Raw PICU mortality was 11.2% (216/1,972 admissions). PICU mortality of patients requiring continuous renal replacement therapy was 54.4% (37/68 patients). Fluid overload (odds ratio, 1.08; 95% CI, 1.01-1.17) and need for inotropic support (odds ratio, 6.53; 95% CI, 1.86-23.08) at the start of continuous renal replacement therapy were associated with PICU mortality. Serum creatinine levels increased above 150% of baseline 3 days before the start of continuous renal replacement therapy. Urine production did not reach the critical limit of oliguria. In contrast, body weight (fluid overload) increased already 5 days prior to continuous renal replacement therapy initiation. PICU mortality of pediatric cancer and hematopoietic stem cell transplant patients requiring continuous renal replacement therapy is sadly high. Fluid overload at the initiation of continuous renal replacement therapy is the most important and earliest predictor of PICU mortality. Our results suggest that the most commonly used criteria of acute kidney injury, that is, serum creatinine and urine production, are not useful as a trigger to initiate continuous renal replacement therapy. This highlights the urgent need for prospective studies to generate recommendations for effective therapeutic interventions at an early phase in this specific patient population.
Identifiants
pubmed: 31464768
doi: 10.1097/CCM.0000000000003973
pmc: PMC6798750
doi:
Substances chimiques
Cardiotonic Agents
0
Creatinine
AYI8EX34EU
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e893-e901Investigateurs
Job van Woensel
(J)
Reinout Bem
(R)
Marc van Heerden
(M)
Maaike Riedijk
(M)
Matthijs de Hoog
(M)
Sascha Verbruggen
(S)
Roelie Wösten-van Asperen
(R)
Martin Kneyber
(M)
Joris Lemson
(J)
Dick van Waardenburg
(D)
P P Roeleveld
(PP)
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