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| Title |
PREDICTORS OF SURVIVORS IN PEDIATRIC RENAL
REPLACEMENT THERAPY (RRT) |
| Author |
TE Bunchman 1, NJ Maxvold 2, GM Annich 2, PD
Brophy 1, TA Mottes 1, JR Custer 2 |
| Affiliation |
Divisions of Pediatric Nephrology 1 &
Critical Care 2 C. S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI
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| Introduction |
Indications for RRT {hemofiltration [HF],
hemodialysis [HD], and peritoneal dialysis [PD]} include acute renal failure (ARF),
metabolic diseases (IEM), intoxications (INX), and hepatic support for liver
transplantation (tx). |
| Method |
Since 1992, 379 children underwent RRT. 96
children with end stage renal disease and 35 requiring ECMO/HF were excluded from this
analysis. RRT modality chosen included HF (n=106), HD (n=83) and PD (n=59). Statistical
significance was set at p < 0.05 for multivariate analysis using the Fischer exact
test. |
| Result |
Characteristics at RRT initiation included; age
(74+11.7mos), weight (wt) (25.3+9.7 kg) and low BP (32%). Survival for each RRT modality
was; HF (40%), HD (81%) and PD (49%) (p < 0.01 HD vs PD/HF). Overall survival was 56%.
Survival by diagnosis (patient number and percent survival): IEM (13;58%), INX (11;100%)
and ARF (224;54%). ARF was composed of BMT (26;42%), malignancy (17;58%), CHD (44;39%),
Heart tx (13;67%), HUS (16;94%), ATN (46;67%), ARDS (5;43%), liver tx (22;17%) and sepsis
(35;33%). Wt predicted survival only in PD patients; survivors (13.9kg+0.8) vs
non-survivors (6.35kg+0.4) (p < 0.01). Statistically longer duration of RRT (in days)
predicted survival vs non-survival in PD (14+1.3 vs 7+0.8; p < 0.01) and HD (13+1.3 vs
7.8+0.9; p < 0.01). Pressor use for HF=74%, PD=81% and HD=33% (p < 0.01 HD vs
HF/PD). 35% of survivors required pressor support whereas 89% did not (p < 0.01).
Hypotension at RRT initiation negatively impacted survival {low BP-32%, normal (nl)
BP-61%, and high BP-100%} (p < 0.01 low vs nl/high BP). |
| Conclusion |
BP at onset and pressor use during RRT predict
patient survival. Patients are best served when RRT is started early, in order to support
nutrition, and cooperatively done with both Nephrology and Critical Care input. |
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