Residual kidney function of Shiga toxin-associated hemolytic uremic syndrome according to kidney replacement therapy: An observational analysis

Background There is no consensus about choice of kidney replacement therapy (KRT) for acute kidney injury (AKI) in Shiga toxin-associated hemolytic uremic syndrome (STEC HUS) in pediatric population. Objective The aim of this study was to analyze residual kidney function (RKF) according to KRT: peritoneal dialysis (PD) versus continuous kidney replacement therapy (CKRT). Methods and settings We conducted a retrospective study in four French pediatric intensive care units (PICUs) over a three-year period from 2018 to 2020. The patients were under 16 years of age, had been admitted to the hospital with STEC HUS and required KRT. Results Of the 44 patients included, 29 were treated with PD, 15 with CKRT, and none with intermittent hemodialysis (IHD). Patients in the PD group were younger (3.0 vs 5.5 years; p<.05) and tended to have a lower HUS severity score (HSS) (15.1 vs 16.8; p = 0.06) compared to the CKRT group. Endpoints were compared between groups adjusted for center, age, HSS, and KRT duration. We observed a higher glomerular filtration rate (GFR) at one year in the PD group compared to the CKRT group (127.0 vs 99.1ml/min/1.73m²; P<.0001). Considering secondary outcomes, patients in the CKRT group received a higher number of red blood cell (RBC) transfusions (p<.01). Conclusion Our retrospective study showed a higher GFR at one year in children with STEC HUS requiring KRT who underwent PD dialysis compared to CKRT. These results should be considered in light of the study’s confounding biases and validated by a prospective randomized study.