(1430) Continuous Renal Replacement Therapy in Children and Young Adults With Heart Disease

Sunday, February 23, 2025

2:30pm – 3:30pm Eastern Time

Location: Connections Central - RST 11

First Author(s)

SM

Susan D. Martin, MD

Associate Professor of Pediatrics, Medical Director of Pediatric Acute Renal Care
Golisano Children's Hospital, University of Rochester Medical Center
E Rochester, New York, United States

Co-Author(s)

PA

Pilar Anton-Martin, MD

MD
LeBonheur Children's Medical Center, United States
AB

Amee Bigelow, MD, MS

.
Nationwide Children's Hospital, Columbus, OH, United States
AC

Abhishek Chakraborty, MD, MBBS

.
Lebonheur Children’s Hospital, Memphis, TN, United States
Dana Fuhrman, DO, MS (she/her/hers)

Children's Hospital of Pittsburgh of UPMC
Pittsburgh, USA
DK

David Kwiatkowski, MD

.
Stanford University School of Medicine, Palo Alto, CA, United States
SK

Sarah Korn, DO

USA
EM

Eleanora Marinari, MD

.
Bambino Gesu Children’s Hospital, Rome, Italy, United States
Shina Menon, MD (she/her/hers)

.
Stanford University School of Medicine, Palo Alto, CA
Seattle, Washington, United States
DS

David Selewski, MD

MD
Medical University of South Carolina, Charleston, SC, United States
MZ

Michael Zappitelli, MD

MD
Hospital for Sick Children, Toronto, Ontario, Canada, United States
TH

Taiki Haga, MD

MD
Osaka City General Hospital, Osaka, Japan, United States
NO

Nicholas Ollberding, n/a

.
Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
VR

Valeria Raggi, MD

.
Bambino Gesu Children’s Hospital, Rome, Italy, United States
SS

Sonia Solomon, MD

MD
Westchester Medical Center, Westchester, NY, USA, United States
KG

Katja M. Gist, DO, MSCS

Pediatric Cardiac Intensivist
Cincinnati Children's Hospital Medical Center, United States
KM

Kenneth Mah, MD

.
Stanford University School of Medicine, Palo Alto, CA, United States

Introduction: The deleterious effects of severe acute kidney injury (AKI) and disorders of fluid balance in children and young adults with cardiac disease are well described. However, data surrounding the use of continuous renal replacement therapy (CRRT) in these patients is lacking. This study aimed to describe clinical characteristics and outcomes of children admitted with a cardiac diagnosis (CardDX) and treated with CRRT.

Methods: The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) is an international multicenter retrospective study including patients (birth to < 25 years) who received CRRT for AKI or fluid overload (FO) from 2015-2021. Exclusion criteria were dialysis dependence and concurrent ECMO. The primary outcomes: 90-day mortality and major adverse kidney events [death, dialysis dependence or creatinine >125% baseline] at 90 days [MAKE-90] were assessed in a CardDx subgroup (medical admission for congenital heart disease [CHD], post-surgical CHD, heart failure/cardiomyopathy [HF/CM]).

Results: Of the 1043 patients included, 123 (11.7%) had CardDX (Medical CHD [26%], Post-surgical CHD [41%], HF/CM [33%]). Compared to other admission diagnoses, those with Card DX, Median [IQR] time to CRRT initiation from ICU admission was longer (4 days, [2-19] vs 2 days, [1-5]; p< 0.001) but there was no difference in %FO at CRRT initiation (9.4% [2.2-22.1% vs 7.2% [2.39-17.60%; p=0.25). There was no difference in 90-day mortality and MAKE-90 between CardDx and the remaining cohort. The 90-day mortality was 56% in medical CHD, 18% in post-surgical CHD and 46% in HF/CM (p < 0.001).

Conclusions: In this multinational cohort, medical CHD suffered the highest mortality and MAKE-90. Modifiable factors such as time to CRRT initiation should be targeted in prospective studies to evaluate with there is improved outcomes.