Fluid Removal in Children on Continuous Renal Replacement Therapy Improves Organ Dysfunction Score

Objectives: To assess impact of fluid removal on improvement in organ function in children who received continuous renal replacement therapy (CRRT) for management of acute kidney injury (AKI) and/or fluid overload (FO). Methods: A retrospective review of eligible patients admitted to a tertiary level intensive care unit over a 3-year period was performed. Improvement in non-renal organ function, the primary outcome, was defined as decrease in non-renal component of Pediatric Logistic Organ Dysfunction (PELOD) score on day 3 of CRRT. The cohort was categorized into Group 1 (improvement) and Group 2 (no improvement or worsening) in non-renal PELOD score. Multivariable logistic regression analysis was performed to identify independent predictors. Results: A higher PELOD score at CRRT initiation (OR 1.11, 95% CI 1.05, 1.18, p<0.001), belonging to infant-age group (OR 4.53, 95% CI 4.40, 5.13, p=0.02) and greater fluid removal during initial 3 days of CRRT (OR 1.05, 95% CI 1.01, 1.10, p=0.01) were associated with an improvement in non-renal PELOD score at day 3 of CRRT. FO at CRRT initiation (OR 0.66, 95% CI 0.46, 0.93, p=0.02) and having an underlying oncologic diagnosis (OR 0.28, 95% CI 0.09, 0.85, p=0.03) were associated with worsening of non-renal PELOD score at day 3 of CRRT. Conclusions: Careful consideration of certain modifiable patient and/or fluid removal kinetic factors may have an impact on outcomes.