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Long-term kidney follow-up after pediatric acute kidney support therapy for children less than 15 kg
BACKGROUND: In small children, acute dialysis (pediatric acute kidney support therapy (paKST)) is increasingly used; however, it is challenging for many reasons. We compared clinical characteristics and predictors of long-term outcomes of patients < 15 kg on peritoneal dialysis (PD), hemodialysis...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Springer Berlin Heidelberg
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10189211/ https://www.ncbi.nlm.nih.gov/pubmed/37195543 http://dx.doi.org/10.1007/s00467-023-06013-w |
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author | Gülçek, Ömer Nazım Gülhan, Bora Kesici, Selman Kurt Şükür, Eda Didem Hayran, Mutlu Ozaltin, Fatih Duzova, Ali Bayrakçı, Benan Topaloglu, Rezan |
author_facet | Gülçek, Ömer Nazım Gülhan, Bora Kesici, Selman Kurt Şükür, Eda Didem Hayran, Mutlu Ozaltin, Fatih Duzova, Ali Bayrakçı, Benan Topaloglu, Rezan |
author_sort | Gülçek, Ömer Nazım |
collection | PubMed |
description | BACKGROUND: In small children, acute dialysis (pediatric acute kidney support therapy (paKST)) is increasingly used; however, it is challenging for many reasons. We compared clinical characteristics and predictors of long-term outcomes of patients < 15 kg on peritoneal dialysis (PD), hemodialysis (HD), and continuous kidney replacement therapy (CKRT). METHODS: Patients with history of paKST (CKRT, HD, PD) weighing < 15 kg and ≥ 6 months of follow-up at Hacettepe University were included. Surviving patients were evaluated at last visit. RESULTS: 109 patients (57 females) were included. Median age at paKST was 10.1 months (IQR: 2–27 months). In total, 43 (39.4%) patients received HD, 37 (34%) PD, and 29 (26.6%) CKRT. 64 (58.7%) patients died a median 3 days (IQR: 2–9.5 days) after paKST. Percentages of patients using vasopressor agents, with sepsis, and undergoing mechanical ventilation were lower in those who survived. After mean follow-up of 2.9 ± 2.1 years, 34 patients were evaluated at mean age 4.7 ± 2.4 years. Median spot urine protein/creatinine was 0.19 (IQR: 0.13–0.37) and 12 patients (35.3%) had non-nephrotic proteinuria. Three patients had estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73m(2) and 2 (6%) had hyperfiltration. In total 22 patients (64.7%) had ≥ 1 kidney risk factor (elevated blood pressure/hypertension, hyperfiltration, eGFR < 90 ml/min/1.73m(2), and/or proteinuria) at last visit. Among 28 patients on paKST < 32 months, 21 had ≥ 1 risk factor (75%), whereas among 6 patients who had paKST ≥ 32 months, one patient had ≥ 1 risk factor (16.7%), (p = 0.014). CONCLUSIONS: Patients on paKST who undergo mechanical ventilation and vasopressor treatment should be followed-up more closely. After surviving the acute period, patients on paKST need to be followed-up closely during the chronic stage. GRAPHICAL ABSTRACT: [Figure: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00467-023-06013-w. |
format | Online Article Text |
id | pubmed-10189211 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-101892112023-05-19 Long-term kidney follow-up after pediatric acute kidney support therapy for children less than 15 kg Gülçek, Ömer Nazım Gülhan, Bora Kesici, Selman Kurt Şükür, Eda Didem Hayran, Mutlu Ozaltin, Fatih Duzova, Ali Bayrakçı, Benan Topaloglu, Rezan Pediatr Nephrol Original Article BACKGROUND: In small children, acute dialysis (pediatric acute kidney support therapy (paKST)) is increasingly used; however, it is challenging for many reasons. We compared clinical characteristics and predictors of long-term outcomes of patients < 15 kg on peritoneal dialysis (PD), hemodialysis (HD), and continuous kidney replacement therapy (CKRT). METHODS: Patients with history of paKST (CKRT, HD, PD) weighing < 15 kg and ≥ 6 months of follow-up at Hacettepe University were included. Surviving patients were evaluated at last visit. RESULTS: 109 patients (57 females) were included. Median age at paKST was 10.1 months (IQR: 2–27 months). In total, 43 (39.4%) patients received HD, 37 (34%) PD, and 29 (26.6%) CKRT. 64 (58.7%) patients died a median 3 days (IQR: 2–9.5 days) after paKST. Percentages of patients using vasopressor agents, with sepsis, and undergoing mechanical ventilation were lower in those who survived. After mean follow-up of 2.9 ± 2.1 years, 34 patients were evaluated at mean age 4.7 ± 2.4 years. Median spot urine protein/creatinine was 0.19 (IQR: 0.13–0.37) and 12 patients (35.3%) had non-nephrotic proteinuria. Three patients had estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73m(2) and 2 (6%) had hyperfiltration. In total 22 patients (64.7%) had ≥ 1 kidney risk factor (elevated blood pressure/hypertension, hyperfiltration, eGFR < 90 ml/min/1.73m(2), and/or proteinuria) at last visit. Among 28 patients on paKST < 32 months, 21 had ≥ 1 risk factor (75%), whereas among 6 patients who had paKST ≥ 32 months, one patient had ≥ 1 risk factor (16.7%), (p = 0.014). CONCLUSIONS: Patients on paKST who undergo mechanical ventilation and vasopressor treatment should be followed-up more closely. After surviving the acute period, patients on paKST need to be followed-up closely during the chronic stage. GRAPHICAL ABSTRACT: [Figure: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00467-023-06013-w. Springer Berlin Heidelberg 2023-05-17 /pmc/articles/PMC10189211/ /pubmed/37195543 http://dx.doi.org/10.1007/s00467-023-06013-w Text en © The Author(s), under exclusive licence to International Pediatric Nephrology Association 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. |
spellingShingle | Original Article Gülçek, Ömer Nazım Gülhan, Bora Kesici, Selman Kurt Şükür, Eda Didem Hayran, Mutlu Ozaltin, Fatih Duzova, Ali Bayrakçı, Benan Topaloglu, Rezan Long-term kidney follow-up after pediatric acute kidney support therapy for children less than 15 kg |
title | Long-term kidney follow-up after pediatric acute kidney support therapy for children less than 15 kg |
title_full | Long-term kidney follow-up after pediatric acute kidney support therapy for children less than 15 kg |
title_fullStr | Long-term kidney follow-up after pediatric acute kidney support therapy for children less than 15 kg |
title_full_unstemmed | Long-term kidney follow-up after pediatric acute kidney support therapy for children less than 15 kg |
title_short | Long-term kidney follow-up after pediatric acute kidney support therapy for children less than 15 kg |
title_sort | long-term kidney follow-up after pediatric acute kidney support therapy for children less than 15 kg |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10189211/ https://www.ncbi.nlm.nih.gov/pubmed/37195543 http://dx.doi.org/10.1007/s00467-023-06013-w |
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