Functional outcomes in pediatric patients on renal replacement therapy in a worldwide registry

Kristin J. Dolan, Baylor College of Medicine, Texas Children's Hospital, Department of Pediatrics, Houston, TX, USA.
Katja M. Gist, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Department of Pediatrics, Denver, CO, USA.
Abby Basalely, Zucker School of Medicine, Cohen Children's Medical Center, Department of Pediatrics, Hyde Park, NY, USA.
Gabriella Bottari, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy.
Abhishek Chakraborty, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Department of Cardiology, Memphis, TN, USA.
Mihaela Damian, Emory University, Arthur M Blank Hospital Children's Healthcare, Department of Pediatrics, Atlanta, GA, USA.
Dana Fuhrman, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Department of Pediatrics, Pittsburgh, PA, USA.
Denise C. Hasson, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Department of Pediatrics, Denver, CO, USA.
Catherine Joseph, Baylor College of Medicine, Texas Children's Hospital, Department of Pediatrics, Houston, TX, USA.
Dave Kwiatkowski, Stanford University School of Medicine, Lucile Packard Children's Hospital, Department of Pediatrics, Palo Alto, CA, USA.
Susan Martin, University of Rochester Medical Center, Golisano Children's Hospital, Department of Pediatrics, Rochester, NY, USA.
Jenn Nhan, George Washington University School of Medicine, Children's National Hospital, Department of Pediatrics, Washington DC, USA.
Nicolas Ollberding, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Cincinnati, OH, USA.
David T. Selewski, Medical University of South Carolina, MUSC Shawn Jenkins Children's Hospital, Department of Pediatrics, Charleston, SC, USA.
Danielle Soranno, Indiana University School of Medicine, Riley Hospital for Children, Department of Pediatrics, Indianapolis, IN, USA.
Michelle C. Starr, Indiana University School of Medicine, Riley Hospital for Children, Department of Pediatrics, Indianapolis, IN, USA.
Amy Strong, Carver College of Medicine, University of Iowa Stead Family Children's Hospital, Department of Pediatrics, Iowa City, IA, USA.
Sameer Thadani, Baylor College of Medicine, Texas Children's Hospital, Department of Pediatrics, Houston, TX, USA.
Huaiyu Zang, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Cincinnati, OH, USA.
Ayse Akcan Arikan, Baylor College of Medicine, Texas Children's Hospital, Department of Pediatrics, Houston, TX, USA.

Document Type

Journal Article

Publication Date

9-29-2025

Journal

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

Volume

40

Issue

10

DOI

10.1093/ndt/gfaf067

Keywords

AKI; dialysis; intensive care; pediatrics; quality of life

Abstract

BACKGROUND AND HYPOTHESIS: Mortality rates of children supported with continuous renal replacement therapy (CRRT) have improved, yet morbidity remains high. We aimed to evaluate the functional outcomes of children receiving CRRT using Functional Status Scale (FSS). We hypothesized that children receiving CRRT will have worse FSS compared with their baseline and acquire new morbidity at hospital discharge and 6 and 12 months post-discharge, and that lack of renal recovery will contribute to worsening functional status. METHODS: This is a retrospective chart review from The Worldwide Exploration of Renal Replacement Outcomes Collaborate in Kidney Disease (WE-ROCK), an international multi-center registry. Twenty-eight centers across five countries participated in this analysis. Children from birth to 25 years, on CRRT for acute kidney injury (AKI) or fluid overload, were included. Patients with underlying kidney disease, on extracorporeal membrane oxygenation and non-survivors were excluded. FSS was collected at discharge (n = 527), 6 months (n = 387) and 12 months post-discharge (n = 344). The primary outcome was FSS at discharge and 6 months. Secondary outcomes included: new morbidity at discharge and 6 months; FSS at 12 months; and the impact of renal recovery on functional outcomes. RESULTS: A total of 527 patients had median FSS of 7 (6, 90) at hospital discharge. Thirty-nine percent (n = 204) had worse FSS. Eighteen percent (95/527) acquired a new morbidity at discharge. Predictors of FSS at discharge were baseline FSS {odds ratio (OR) 1.30 [95% confidence interval (CI) 1.11-1.52]}, weight [OR 0.99 (95% CI 0.98-0.9997)], comorbidities [OR 1.88 (95% CI 1.16-3.04)], mechanical ventilation [OR 1.72 (95% CI 1.04-2.85)] and sepsis on intensive care unit admission [OR 1.46 (95% CI 1.01-2.21)]. A total of 387 patients had median FSS score of 6 (6, 8) at 6 months. Ten percent (n = 39/387) acquired new morbidity at 6 months. The significant predictors of FSS at 6 months were FSS at discharge [OR 2.36 (95% CI 1.95-2.84)] and presence of comorbidities [OR 1.77 (95% CI 1.03-3.06)]. CONCLUSION: This is the first large, multi-center study evaluating functional outcomes of children on CRRT. Persistent morbidity following discharge emphasizes the importance of comprehensive identification and multidisciplinary follow-up to optimize patient outcomes.

Department

Pediatrics

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