Factors influencing circuit lifetime in paediatric continuous kidney replacement therapies - results from the EurAKId registry

被引：3

作者：

Deja, Anna ^{[1
]}

Guzzo, Isabella ^{[2
]}

Cappoli, Andrea ^{[2
]}

Labbadia, Raffaella ^{[2
]}

Bayazit, Aysun Karabay ^{[3
]}

Yildizdas, Dincer ^{[3
]}

Schmitt, Claus Peter ^{[4
]}

Tkaczyk, Marcin ^{[5
]}

Cvetkovic, Mirjana ^{[6
]}

Kostic, Mirjana ^{[6
]}

Hayes, Wesley ^{[7
]}

Shroff, Rukshana ^{[7
]}

Jankauskiene, Augustina ^{[8
,9
]}

Virsilas, Ernestas ^{[8
,9
]}

Longo, Germana ^{[10
]}

Vidal, Enrico ^{[10
]}

Mir, Sevgi ^{[11
]}

Bulut, Ipek Kaplan ^{[11
]}

Pasini, Andrea ^{[12
]}

Paglialonga, Fabio ^{[13
]}

Montini, Giovanni ^{[13
]}

Yilmaz, Ebru ^{[14
]}

Costa, Liane Correia ^{[15
]}

Teixeira, Ana ^{[15
]}

Schaefer, Franz ^{[4
]}

机构：

[1] Med Univ Warsaw, Dept Paediat Nephrol, Warsaw, Poland

[2] Bambino Gesu Childrens Hosp IRCCS, Div Nephrol, Dialysis & Transplant Unit, Rome, Italy

[3] Cukurova Univ, Fac Med, Dept Pediat Nephrol, Adana, Turkiye

[4] Heidelberg Univ Hosp, Ctr Pediat & Adolescent Med, Div Pediat Nephrol, Heidelberg, Germany

[5] Polish Mothers Mem Hosp Res Inst, Dept Pediat & Immunol, Nephrol Div, Lodz, Poland

[6] Univ Children Hosp, Dept Nephrol, Belgrade, Serbia

[7] UCL Great Ormond St Hosp, Dept Pediat Nephrol, London, England

[8] Inst Child Hlth, London, England

[9] Vilnius Univ, Inst Clin Med, Clin Pediat, Vilnius, Lithuania

[10] Univ Padua, Dept Womans & Childrens Hlth, Dialysis & Transplant Unit, Pediat Nephrol, Padua, Italy

[11] Ege Univ, Fac Med, Dept Pediat Nephrol, Izmir, Turkiye

[12] IRCCS Azienda Osped Univ Bologna, Pediat Oncol & Hematol Unit, Bologna, Italy

[13] Fdn IRCCS Ca Granda, Osped Maggiore Policlin, Pediat Nephrol Dialysis & Transplant Unit, Milan, Italy

[14] Dr Behcet Children Res & Educ Hosp, Dept Pediat Nephrol, Izmir, Turkiye

[15] Ctr Materno Infantil Norte, Dept Pediat Nephrol, Porto, Portugal

来源：

PEDIATRIC NEPHROLOGY | 2024年 / 39卷 / 11期

关键词：

Acute kidney injury; Continuous kidney replacement therapy; Circuit lifetime; Regional citrate anticoagulation; CONTINUOUS RENAL REPLACEMENT; SYSTEMIC HEPARIN ANTICOAGULATION; REGIONAL CITRATE; HEMOFILTRATION; SURVIVAL; SIZE;

D O I：

10.1007/s00467-024-06459-6

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

Background Continuous kidney replacement therapy (CKRT) has recently become the preferred kidney replacement modality for children with acute kidney injury (AKI). We hypothesise that CKRT technical parameters and treatment settings in addition to the clinical characteristics of patients may influence the circuit lifetime in children. Methods The study involved children included in the EurAKId registry (NCT 02960867), who underwent CKRT treatment. We analysed patient characteristics and CKRT parameters. The primary end point was mean circuit lifetime (MCL). Secondary end points were number of elective circuit changes and occurrence of dialysis-related complications. Results The analysis was composed of 247 children who underwent 37,562 h of CKRT (median 78, IQR 37-165 h per patient). A total of 1357 circuits were utilised (3, IQR 2-6 per patient). MCL was longer in regional citrate anticoagulation (RCA), compared to heparin (HA) and no anticoagulation (NA) (42, IQR 32-58 h; 24, IQR 14-34 h; 18, IQR 12-24 h, respectively, p < 0.001). RCA was associated with longer MCL regardless of the patient's age or dialyser surface. In multivariate analysis, MCL correlated with dialyser surface area (beta = 0.14, p = 0.016), left internal jugular vein vascular access site (beta = -0.37, p = 0.027), and the use of HA (beta = -0.14, p = 0.038) or NA (beta = -0.37, p < 0.001) vs. RCA. RCA was associated with the highest ratio of elective circuit changes and the lowest incidence of complications. Conclusion Anticoagulation modality, dialyser surface, and vascular access site influence MCL. RCA should be considered when choosing first-line anticoagulation for CKRT in children. Further efforts should focus on developing guidelines and clinical practice recommendations for paediatric CKRT. Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

引用

页码：3353 / 3362

页数：10

共 35 条

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