Paediatric anaesthesia & critical care
Characteristics and Outcomes of Children and Young Adults With Sepsis Requiring Continuous Renal Replacement Therapy: A Comparative Analysis From the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK)*
Authors' conclusion
Septic children requiring CRRT have different clinical characteristics and outcomes compared with those without sepsis, including higher rates of mortality and MAKE-90. Increasing duration of vasoactive support during the first week of CRRT, a surrogate of potential dialytrauma, appears to be associated with these outcomes.
Study context
- Population
- Patients 0–25 years old requiring continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) and/or fluid overload; neonatal, cardiac and PICUs at 34 centers in nine countries, 2015–2021
- Participants
- 1,016 patients · 34 centers
- Comparison
- Sepsis vs no sepsis at CRRT initiation
- Septicn = 446
- Primary endpoint
- Major Adverse Kidney Events:
- MAKE-90: composite of death
- RRT dependence
- > 25% decline in eGFR from baseline
- Follow-up
- 90 days from CRRT initiation
Methodological detailsmulticenter
- Multicenter
Primary result
As reported in the abstract
MAKE-90 · 90 days
P = 0.002
Further findings
Liberation from CRRT · 28 days
P < 0.001
Mortality
P < 0.001
RRT dependence among survivors · 90 days
P = 0.011
| Outcome | aOR (95% CI) | |
|---|---|---|
| Duration of vasoactive requirement (per additional day) and MAKE-90 / mortality (multivariable regression)Each additional day of vasoactive support · MAKE-90 | 1.16 (1.05–1.28) | |
| Duration of vasoactive requirement (per additional day) and MAKE-90 / mortality (multivariable regression)Each additional day of vasoactive support · mortality | 1.20 (1.1–1.32) | |
| 0.512Adjusted odds ratio (log scale) |
Duration of vasoactive requirement (per additional day) and MAKE-90 / mortality (multivariable regression)
- Pre-CRRT vasoactive requirement, time to negative fluid balance and median daily fluid balance over first week of CRRT not associated with MAKE-90
Original publication
Characteristics and Outcomes of Children and Young Adults With Sepsis Requiring Continuous Renal Replacement Therapy: A Comparative Analysis From the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK)*. Crit Care Med. Published 11 September 2024. doi:10.
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