Changing trends in dialysis modalities utilization and mortality in children, adolescents and young adults with acute kidney injury, 2010–2017

AbstractThe aim of the study was to assess trends in the relative use of dialysis modalities in the hospital-based pediatric cohort and to determine risk factors associated with in-hospital morality among pediatric patients receiving dialysis for acute kidney injury (AKI). Patients aged < 20 years who received dialysis between 2010 and 2017 were identified from electronic health records databases of a Taiwan’s healthcare delivery system. The annual uses of intermittent hemodialysis (HD), continuous and automated peritoneal dialysis (PD) and continuous kidney replacement therapy (CKRT) were assessed using Cochran-Armitage Tests for trend. Among patients who received their first dialysis as inpatients for AKI, a multivariate logistic regression model was employed to assess mortality risks associated with dialysis modalities, patient demographics, complexity of baseline chronic disease, and healthcare service use during their hospital stays. Kidney dialysis was performed 37.9 per patient per year over the study period. Intermittent hemodialysis (HD) (73.3%) was the most frequently used dialysis modality. In the inpatient setting, the relative annual use of CKRT increased over the study period, while HD use concomitantly declined (P < 0.0001). The overall in-hospital mortality rate after dialysis for AKI was 33.6%, which remained steady over time (P = 0.2411). Patients aged < 2 years [adjusted odds ratio: (aOR) 3.36; 95% confidence interval (CI) 1.34–8.93] and greater vasoactive regimen use (aOR: 17.1; 95% CI: 5.3–55.21) were significantly associated with dialysis-related mortality. Overall treatment modality used for dialysis in pediatric patients increased slowly in the study period, and HD and CRKT modality uses largely evolved in the inpatient setting. Younger ages and use of more vasoactive medication regimens were independently associated with increased early mortality in patients on AKI-dialysis.

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Prediction and Clinically Important Factors of Acute Kidney Injury Non-recovery

Frontiers in Medicine ◽

10.3389/fmed.2021.789874 ◽

2022 ◽

Vol 8 ◽

Author(s):

Chien-Liang Liu ◽

You-Lin Tain ◽

Yun-Chun Lin ◽

Chien-Ning Hsu

Keyword(s):

Acute Kidney Injury ◽

Risk Model ◽

Healthcare Delivery ◽

Kidney Injury ◽

Gradient Boosting ◽

Healthcare Delivery System ◽

Post Discharge ◽

Electronic Health Record Data ◽

Temporal Validation ◽

Extreme Gradient Boosting

ObjectiveThis study aimed to identify phenotypic clinical features associated with acute kidney injury (AKI) to predict non-recovery from AKI at hospital discharge using electronic health record data.MethodsData for hospitalized patients in the AKI Recovery Evaluation Study were derived from a large healthcare delivery system in Taiwan between January 2011 and December 2017. Living patients with AKI non-recovery were used to derive and validate multiple predictive models. In total, 64 candidates variables, such as demographic characteristics, comorbidities, healthcare services utilization, laboratory values, and nephrotoxic medication use, were measured within 1 year before the index admission and during hospitalization for AKI.ResultsAmong the top 20 important features in the predictive model, 8 features had a positive effect on AKI non-recovery prediction: AKI during hospitalization, serum creatinine (SCr) level at admission, receipt of dialysis during hospitalization, baseline comorbidity of cancer, AKI at admission, baseline lymphocyte count, baseline potassium, and low-density lipoprotein cholesterol levels. The predicted AKI non-recovery risk model using the eXtreme Gradient Boosting (XGBoost) algorithm achieved an area under the receiver operating characteristic (AUROC) curve statistic of 0.807, discrimination with a sensitivity of 0.724, and a specificity of 0.738 in the temporal validation cohort.ConclusionThe machine learning model approach can accurately predict AKI non-recovery using routinely collected health data in clinical practice. These results suggest that multifactorial risk factors are involved in AKI non-recovery, requiring patient-centered risk assessments and promotion of post-discharge AKI care to prevent AKI complications.

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Analysis of Acute Kidney Injury in Pediatric Patients with Stem Cell Transplantation

Journal of the Korean Society of Pediatric Nephrology ◽

10.3339/jkspn.2009.13.2.130 ◽

2009 ◽

Vol 13 (2) ◽

pp. 130

Author(s):

Sae Yoon Kim ◽

Jung Youn Choi ◽

Jeong Ok Hah ◽

Yong Hoon Park

Keyword(s):

Acute Kidney Injury ◽

Stem Cell ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Pediatric Patients ◽

Kidney Injury

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Acute kidney injury in pediatric patients hospitalized with acute COVID-19 and multisystem inflammatory syndrome in children associated with COVID-19

Kidney International ◽

10.1016/j.kint.2021.02.026 ◽

2021 ◽

Author(s):

Abby Basalely ◽

Shari Gurusinghe ◽

James Schneider ◽

Sareen S. Shah ◽

Linda B. Siegel ◽

...

Keyword(s):

Acute Kidney Injury ◽

Pediatric Patients ◽

Kidney Injury ◽

Inflammatory Syndrome

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Indications for Dialysis in Acute Kidney Injury

10.2310/nephro.12038 ◽

2020 ◽

Author(s):

Ankit Patel ◽

Kenneth B Christopher

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

High Efficiency ◽

Kidney Injury ◽

Intermittent Hemodialysis ◽

Continuous Venovenous Hemofiltration ◽

Continuous Venovenous Hemodialysis ◽

Low Efficiency ◽

The Impact

Renal replacement therapy (RRT) can be used to support patient’s kidney function in cases of acute kidney injury (AKI). However, timing, modality, and dosing of RRT continue to remain in question. Recent studies have begun to provide data to help guide clinicians on when to initiate RRT, what form of RRT to use ranging from continuous venovenous hemofiltration (VVH) to intermittent hemodialysis, and the impact of high versus low-intensity dosing. Additionally, the risks associated with temporary vascular access with regard to thrombosis and infection, the impact of high efficiency and flux versus low efficiency and flux membranes, and options for anticoagulation in RRT for AKI are also discussed. This review contains 75 references. Key words: acute kidney injury, chronic kidney disease, continuous venovenous hemofiltration, continuous venovenous hemodialysis, renal replacement therapy, venovenous hemofiltration,

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Incidence of Nephrotoxicity Among Pediatric Patients Receiving Vancomycin With Either Piperacillin–Tazobactam or Cefepime: A Cohort Study

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piy030 ◽

2018 ◽

Vol 8 (3) ◽

pp. 221-227 ◽

Cited By ~ 11

Author(s):

Kathryn M Cook ◽

Jessica Gillon ◽

Alison G Grisso ◽

Ritu Banerjee ◽

Natalia Jimenez-Truque ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cohort Study ◽

Pediatric Patients ◽

Kidney Injury ◽

Matched Cohort ◽

Matched Cohort Study

In this matched-cohort study of pediatric inpatients, 28.9% of those treated with a combination of piperacillin–tazobactam and vancomycin developed acute kidney injury, compared to 7.9% in those treated with cefepime and vancomycin (P < .001).

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Intensity of Renal Support in Critically Ill Patients with Acute Kidney Injury

50 Studies Every Intensivist Should Know ◽

10.1093/med/9780190467654.003.0037 ◽

2018 ◽

pp. 221-226

Author(s):

Eric Ehieli ◽

Yuriy Bronshteyn

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Statistical Difference ◽

Kidney Injury ◽

Intermittent Hemodialysis ◽

Replacement Strategy ◽

Therapy Regimen ◽

Continuous Venovenous Hemodiafiltration ◽

Multicenter Prospective Study

Patients with severe acute kidney injury who require renal replacement therapy have high mortality rates. Controversy exists over whether a mortality benefit occurs with use of a more intensive renal replacement therapy regimen. In this multicenter, prospective study, 1124 patients requiring renal replacement therapy for severe acute kidney injury were randomized to a more and a less intensive renal replacement therapy regimen and were followed for 60 days. There was no statistical difference in mortality at 60 days (53.6% intensive, 51.5% less intensive, P = 0.47) and no difference in kidney recovery or non-renal organ failure. Hypotension and electrolyte abnormalities were more common in the intensive renal replacement regimen. A less intensive renal replacement regimen (intermittent hemodialysis 3 times a week or continuous venovenous hemodiafiltration at 20ml/kg/hour) was found noninferior to a more intensive renal replacement strategy (dialysis 6 times per week or continuous venovenous hemodiafiltration at 35 ml/kg/hour).

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Intermittent Hemodialysis For Patients With Acute Kidney Injury (AKI): Outcome In A Tertiary Level Hospital

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v17i1.18629 ◽

2018 ◽

Vol 17 (1) ◽

pp. 25-30

Author(s):

Arun Sharma ◽

Binod Karki ◽

Ajay Rajbhandari

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Acute Gastroenteritis ◽

Kidney Injury ◽

Tertiary Level ◽

Intermittent Hemodialysis ◽

The Mean ◽

Level Hospital

INTRODUCTION: Acute kidney injury (AKI) is the sudden loss of renal function with accumulation of nitrogenous waste compounds. In developing countries, community acquired AKI is common than AKI in hospitalized septic patients. With conservative management many patients recover renal function however few require renal support with intermittent Hemodialysis (HD). We conducted a study to find out the etiology and outcome of the patients presenting with AKI who required dialysis.METHODS: This is a descriptive follow up study of the patients who needed renal replacement therapy in the form of HD presenting to our Nephrology unit of the hospital over a period of two years. Patients were followed up for three months post discharge. Data were tabulated and analyzed using SPSS software.RESULTS: Total 50 patients were included in study with 67% male. The commonest etiologies were urinary tract infection (30%) and acute gastroenteritis (24%).The mean creatinine at the time of nephrology consultation, maximum level and at the time of discharge were 6.5(SD± 2.62), 7.3(SD ±2.13) and 2.2(SD ±1.75) respectively. Uremia with anuria was the most common reason for the initiation of HD in 54% cases. The mean number of intermittent HD used was 3.36. Complete recovery was seen in 68%, death in 26% and CKD in 6%.CONCLUSION: UTI followed by acute gastroenteritis are the leading cause of AKI in our tertiary level hospital. Timely initiated renal replacement therapy in the form of intermittent HD could lead to substantial renal recovery in almost three fourth of patients.

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