Study on Major Adverse Kidney Events in Pediatric Continuous Kidney Replacement Therapy

UPMC Children’s Hospital of Pittsburgh Division of Pediatric Nephrology researcher Dana Y. Fuhrman, DO, MS, associate professor of Pediatrics and Critical Care Medicine, was the lead author on a recent study from the multicenter international collaborative, the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) registry. Dr. Fuhrman also is the director of the CKRT Program at UPMC Children’s and program director of the Pediatric Critical Care Medicine Fellowship.

The new paper provides fresh insights into the incidence and risk factors associated with major adverse kidney events after 90 days (MAKE-90) in pediatric patients undergoing continuous kidney replacement therapy (CKRT). The study was published in February 2024 in JAMA Network Open.

“AKI continues to be a common consequence of being in the ICU for all patients,” says Dr. Fuhrman. “While CKRT is a valuable therapy to help patients recover from AKI or other fluid imbalances as a result of kidney dysfunction, how it is used, for how long, and how patients are weaned or removed from the therapy plays very important roles in experiencing MAKE-90, including patient-specific factors.”

Study Details and Findings

The study examined data from 969 patients aged 0 to 25 years from the WE-ROCK registry, treated with CKRT between 2015 and 2021. The primary outcome measure of the study was the incidence of MAKE-90, which for this study was defined as death, a persistent kidney dysfunction marked by a ≥ 25% decline in estimated eGFR), or the need for dialysis 90 days after starting CKRT.

The study found that 65% of the patients treated with CKRT developed MAKE-90. The investigation found risk factors associated with higher odds of experiencing MAKE-90 included a cardiac comorbidity, a longer ICU admission time before being placed on CKRT, and the pattern of CKRT liberation, which is the process for achieving cessation of CKRT.

The research also uncovered that successful liberation from CKRT within 28 days was associated with significantly lower odds of MAKE-90 compared to patients who were unable to be taken off CKRT or those for whom it was attempted but did not work. Patients that were successfully liberated from CKRT had a 68% lower chance of experiencing MAKE-90 compared to those who had CKRT restarted and a 98% lower chance when compared to patients in which CKRT liberation was never attempted.

Implications for Clinical Practice

The findings from the study from the WE-ROCK collaborators shows the importance of early and effective CKRT liberation attempts to potentially reduce the incidence of adverse kidney events.

Successful CKRT liberation can help to improve patient outcomes, which emphasizes the need to develop more standardized liberation practices and early intervention strategies.

“With such a high incidence of MAKE-90 in the population we examined, it shows a need for additional research and targeted interventions to address possible long-term kidney dysfunction and mortality,” says Dr. Fuhrman.

Reference

Fuhrman DY, Stenson EK, Alhamoud I, et al. Major Adverse Kidney Events in Pediatric Continuous Kidney Replacement Therapy. JAMA Netw Open. 2024; 7(2): e240243.

Further Reading

Learn more about the WE-ROCK research collaborative by visiting their website.

Learn more about Dr. Fuhrman and the Division of Pediatric Nephrology at UPMC Children’s.