Prognostic Factors in Children with Acute Kidney Injury Requiring Continuous Renal Replacement Therapy

Abstract

<b><i>Introduction:</i></b> This study aimed to evaluate prognostic factors and outcomes in a single-center PICU cohort that received continuous renal replacement therapy (CRRT). <b><i>Methods:</i></b> This retrospective study analyzed clinical characteristics, laboratory data, and outcomes. Ninety-day mortality and advanced chronic kidney disease (CKD) (eGFR &lt;60 mL/min/1.73 m²) were defined as primary and secondary outcomes, respectively. <b><i>Results:</i></b> Seventy-five patients were enrolled, all of whom received CRRT for indications including acute kidney injury with complicated refractory metabolic acidosis, electrolyte derangement, and existed or impending fluid overload. The 90-day mortality and advanced CKD were 53% and 29%, respectively. Multivariate Cox regression analysis demonstrated that only underlying bone marrow transplantation (BMT) (HR 4.58; 95% CI: 2.04–10.27) and a high pSOFA score (HR 1.12; 95% CI: 1.01–1.23) were independent risk factors for 90-day mortality. Among survivors, ten developed advanced CKD on the 90th day, and this group had a higher serum fibrinogen level (OR 1.01; 95% CI: 1.01–1.03) at the start of CRRT. <b><i>Conclusion:</i></b> In critically ill children with AKI requiring CRRT, post-BMT and high pSOFA scores are independent risk factors for 90-day mortality. Additionally, a high serum fibrinogen level at the initiation of CRRT is associated with the development of advanced CKD.