Introduction: Mortality associated with Continuous renal replacement therapy (CRRT) use in the PICU is reported to be 25-60%. Data supports the use of CRRT in fluid overload (FO) and acute kidney injury (AKI), with lower mortality rates reported with earlier use. The last several years have shown an increase in the use of CRRT for a broader range of indications. This study aims to evaluate outcomes in children undergoing CRRT based on their primary indications and to better characterize the outcomes for patients who received CRRT for AKI secondary to sepsis. Methods: We performed a retrospective chart review of patients who underwent CRRT using the Prismax machine in our PICU from 2020-2023. The primary outcome measured was mortality, defined as death occurring within the hospital admission. Secondary outcomes included ventilator days, ICU length of stay (LOS), hospital LOS, and complication rates. The indications for CRRT were diverse and included fluid overload (FO), AKI, hyperammonemia, acidosis, and electrolyte derangement. Patients with chronic kidney disease, those who received extracorporeal liver support or Carpediem or Aquadex therapy were excluded. Complications tracked included anemia, thrombocytopenia, hemolysis, electrolyte derangement, hypothermia, hypotension, line associated thrombus, and line associated infection. Results: The presented data is provisional. We reviewed 95 patients; 61 met inclusion criteria. The overall mortality rate was 37.7%. The median hospital and PICU lengths of stay were 28 and 13 days respectively. Patients required invasive ventilation for a median of 5 days. The most common indication was AKI. Patients with sepsis had a mortality rate of 41.6% compared to 36.7% in non-septic patients. The incidence of CRRT-associated complications was high; 98% of patients experienced at least one and 70% had >3 complications. Conclusions: Our data shows mortality remains high in patients undergoing CRRT, with increased mortality observed in septic patients compared to non-septic patients. High complication rates, unprecedented in literature, necessitate further investigation. Future analyses will aim to determine the statistical significance of differences in mortality rates based on CRRT indications, as well as between septic and non-septic patients.
Neale et al. (Sun,) studied this question.