(1407) Characteristics of Children With New Hematologic Malignancy Based on CKRT Administration

Introduction: Children with hematologic malignancy can develop potentially lethal tumor lysis syndrome (TLS). Continuous kidney replacement therapy (CKRT) can support severe cases of TLS. Literature describing children treated with CKRT for TLS is sparse. Thus, we aimed to describe the characteristics of children with newly diagnosed hematologic malignancy treated with CKRT during their initial hospitalization to identify factors associated with the use of CKRT. We hypothesized hyperkalemia, T cell disease, higher white blood cell count (WBC), and hyperuricemia would be associated with CKRT use.

Methods: A retrospective chart review of 229 children from birth to 21yrs admitted between Jan 2016-Dec 2022 to a New York tertiary care children’s hospital with new diagnoses of leukemia or lymphoma was performed. Patients were placed into cohorts based on use of CKRT (Y/N) during hospitalization. The primary outcome measured was the difference in presenting potassium. Secondary outcomes were presenting WBC and uric acid, malignancy type, and discharge eGFR. Evaluation of associations for those treated with CKRT was performed via Chi Square tests for dichotomous variables and Wilcoxon rank-sum tests for continuous variables.

Results: Of 229 patients included, 22 (9.6%) were treated with CKRT. All patients treated with CKRT were managed with low-dose heparin for circuit anticoagulation, with a mean duration of 115hrs (SD 63) with a median of 1 filter change/run. Those with T-ALL and Burkitt’s Lymphoma were more likely to have received CKRT compared to all other diagnoses (p < 0.001). Those administered CKRT had a higher median presenting WBC (108 vs. 9.8 K/uL, p< 0.0001) and higher median presenting potassium (4.5 vs. 4.1 mmol/L, p=0.003) but no difference in uric acid (8.6 vs 4.7 mg/dL, p=0.07). Mortality for those who received CKRT was 18.2%vs 1.0% for those who did not receive CKRT. Treatment with CKRT was not associated with eGFR at discharge (p=0.07).

Conclusions: Higher presenting potassium and WBC were associated with CKRT use. Those with T-ALL and Burkitt’s Lymphoma were more likely to receive CKRT than those with other newly diagnosed hematologic malignancies. These results can inform future prospective trials with identifying children with TLS who may benefit from CKRT.