Background: Continuous kidney replacement therapy (CKRT) is often used for acute kidney injury (AKI) or fluid overload (FO) in children ≤ 10 kg. Intensive care unit (ICU) mortality in children ≤ 10 kg reported by the prospective pediatric CRRT (ppCRRT, 2001–2003) registry was 57%. We aimed to evaluate characteristics associated with ICU mortality using a contemporary registry. Methods: The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) registry is a retrospective, multinational, observational study of children and young adults aged 0–25 years receiving CKRT (2015–2021) for AKI or FO. This analysis included patients ≤ 10 kg at hospital admission. Primary and secondary outcomes: ICU mortality and major adverse kidney events at 90 days (MAKE-90) defined as death, persistent kidney dysfunction, or dialysis within 90 days, respectively. Results: A total of 210 patients were included (median age 0.53 years (IQR, 0.1, 0.9)). ICU mortality was 46.5%. MAKE-90 occurred in 150/207 (72%). CKRT was initiated at a median 3 days (IQR 1, 9) after ICU admission and lasted a median 6 days (IQR 3, 16). On multivariable analysis, pediatric logistic organ dysfunction score (PELOD-2) at CKRT initiation was associated with increased odds of ICU mortality (aOR 2.64, 95% CI 1.68–4.16), and increased odds of MAKE-90 (aOR 2.2, 95% CI 1.31–3.69). Absence of comorbidity was associated with lower MAKE-90 (aOR 0.29, 95%CI 0.13–0.65). Conclusions: We report on a contemporary cohort of children ≤ 10 kg treated with CKRT for acute kidney injury and/or fluid overload. ICU mortality is decreased compared to ppCRRT. The extended risk of death and morbidity at 90 days highlights the importance of close follow-up. Graphical abstract: (Figure presented.)
Characteristics and outcomes of children ≤ 10 kg receiving continuous kidney replacement therapy: a WE-ROCK study / Menon, Shina; Starr, Michelle C.; Zang, Huaiyu; Collins, Michaela; Damian, Mihaela A.; Fuhrman, Dana; Krallman, Kelli; Soranno, Danielle E.; Webb, Tennille N.; Slagle, Cara; Joseph, Catherine; Martin, Susan D.; Mohamed, Tahagod; Beebe, Morgan E.; Ricci, Zaccaria; Ollberding, Nicholas; Selewski, David; Gist, Katja M.; null, null; Ahern, Emily; Arikan, Ayse Akcan; Alhamoud, Issa; Alobaidi, Rashid; Anton-Martin, Pilar; Balani, Shanthi S.; Barhight, Matthew; Basalely, Abby; Bigelow, Amee M.; Bottari, Gabriella; Cappoli, Andrea; Ciccia, Eileen A.; Colosimo, Denise; Cortina, Gerard; De la Mata Navazo, Sara; DeAbreu, Gabrielle; Deep, Akash; Ding, Kathy L.; Dolan, Kristin J.; Lafever, Sarah NFernandez; Gelbart, Ben; Gorga, Stephen M.; Guzzi, Francesco; Guzzo, Isabella; Haga, Taiki; Harvey, Elizabeth; Hasson, Denise C.; Hill-Horowitz, Taylor; Inthavong, Haleigh; Kaddourah, Ahmad; Kakajiwala, Aadil; Kessel, Aaron D.; Korn, Sarah; Kwiatkowski, David M.; Lee, Jasmine; Lequier, Laurance; Kia, Tina Madani; Mah, Kenneth E.; Marinari, Eleonora; Morgan, Catherine; Mottes, Theresa A.; Muff-Luett, Melissa A.; Namachivayam, Siva; Neumayr, Tara M.; Nhan, Jennifer; O'Rourke, Abigail; Pinto, Matthew G.; Qutob, Dua; Raggi, Valeria; Reynaud, Stephanie; Rumlow, Zachary A.; Lozano, María JSantiago; See, Emily; Serpe, Carmela; Serratore, Alyssa; Shah, Ananya; Shih, Weiwen V.; Shin, HStella; Solomon, Sonia; Srivastava, Rachana; Stanski, Natalja L.; Stenson, Erin K.; Strong, Amy E.; Taylor, Susan A.; Thadani, Sameer V.; Uber, Amanda M.; Van Wyk, Brynna; Zangla, Emily E.; Zappitelli, Michael; Alvarez, T. Christine E.; Bixler, Elizabeth; Brown, Erica Blender; Brown, Cheryl L.; Burrell, Ambra; Dash, Anwesh; Ehrlich, Jennifer L.; Farma, Simrandeep; Gahring, Kim; Gales, Barbara; Hilgenkamp, Madison R.; Jain, Sonal; Kanwar, Kate; Lusk, Jennifer; Meyer, Christopher J.; Plomaritas, Katherine; Porter, Joshua; Potts, Jessica; Serratore, Alyssa; Schneider, Elizabeth; Sinha, Vidushi; Strack, P. J.; Taylor, Sue; Twombley, Katherine; Van Wyk, Brynna; Wallace, Samantha; Wang, Janet; Woods, Megan; Zinger, Marcia; Zong, Alison. - In: PEDIATRIC NEPHROLOGY. - ISSN 0931-041X. - ELETTRONICO. - 40:(2025), pp. 253-264. [10.1007/s00467-024-06438-x]
Characteristics and outcomes of children ≤ 10 kg receiving continuous kidney replacement therapy: a WE-ROCK study
Ricci, Zaccaria;Colosimo, Denise;Guzzi, Francesco;
2025
Abstract
Background: Continuous kidney replacement therapy (CKRT) is often used for acute kidney injury (AKI) or fluid overload (FO) in children ≤ 10 kg. Intensive care unit (ICU) mortality in children ≤ 10 kg reported by the prospective pediatric CRRT (ppCRRT, 2001–2003) registry was 57%. We aimed to evaluate characteristics associated with ICU mortality using a contemporary registry. Methods: The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) registry is a retrospective, multinational, observational study of children and young adults aged 0–25 years receiving CKRT (2015–2021) for AKI or FO. This analysis included patients ≤ 10 kg at hospital admission. Primary and secondary outcomes: ICU mortality and major adverse kidney events at 90 days (MAKE-90) defined as death, persistent kidney dysfunction, or dialysis within 90 days, respectively. Results: A total of 210 patients were included (median age 0.53 years (IQR, 0.1, 0.9)). ICU mortality was 46.5%. MAKE-90 occurred in 150/207 (72%). CKRT was initiated at a median 3 days (IQR 1, 9) after ICU admission and lasted a median 6 days (IQR 3, 16). On multivariable analysis, pediatric logistic organ dysfunction score (PELOD-2) at CKRT initiation was associated with increased odds of ICU mortality (aOR 2.64, 95% CI 1.68–4.16), and increased odds of MAKE-90 (aOR 2.2, 95% CI 1.31–3.69). Absence of comorbidity was associated with lower MAKE-90 (aOR 0.29, 95%CI 0.13–0.65). Conclusions: We report on a contemporary cohort of children ≤ 10 kg treated with CKRT for acute kidney injury and/or fluid overload. ICU mortality is decreased compared to ppCRRT. The extended risk of death and morbidity at 90 days highlights the importance of close follow-up. Graphical abstract: (Figure presented.)
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