According to a recent study published in JAMA Network Open, the timing of continuous renal replacement therapy (CRRT) is crucial for the survival of children with acute kidney injury (AKI) or volume overload in the intensive care unit (ICU).

The study, conducted by researchers from the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) registry, analyzed data from 969 pediatric critical care patients. The findings revealed that early initiation of CRRT could be life-saving for pediatric patients with AKI or volume overload.

The results showed that CRRT initiation was significantly delayed among patients who experienced death, dialysis dependence, or a more than 25% decline in estimated glomerular filtration rate (eGFR) within 90 days, collectively termed MAKE-90. The delay in CRRT initiation was associated with increased odds of MAKE-90 and 90-day mortality.

Specifically, the study found that each 1-day delay in CRRT initiation was linked to a 3% increased odds of MAKE-90 and a 4% increased odds of 90-day mortality. Furthermore, CRRT delayed for 6 days after ICU admission was significantly associated with a 21% increased odds of MAKE-90 compared with CRRT performed on day 1.

The mortality rate at 90 days was significantly higher among pediatric patients with late CRRT initiation (more than 2 days after ICU admission) than among those with early initiation (2 or fewer days after ICU admission).

Dr. Katja M. Gist, the lead researcher from Cincinnati Children’s Hospital Medical Center, emphasized the significance of the findings, particularly in identifying at-risk patients early in their ICU course. The study highlighted the need to develop stratification tools for early detection of at-risk pediatric patients.

Among the pediatric patients who survived, 44% had persistent kidney dysfunction, and 35% of these patients were dialysis dependent. The study, however, lacked information on when AKI occurred, its etiology, and the indication for CRRT initiation, indicating the need for further research to determine the optimal timing of CRRT in children, as well as dosage, fluid removal, and anticoagulation.

Additionally, results from a separate study suggested that correcting serum creatinine for fluid balance may improve the diagnosis of AKI in infants, further emphasizing the importance of ongoing research in this area.