Functional outcomes in pediatric patients on renal replacement therapy in a worldwide registry

Kristin J Dolan; Katja M Gist; Abby Basalely; Gabriella Bottari; Abhishek Chakraborty; Mihaela Damian; Dana Fuhrman; Denise C Hasson; Catherine Joseph; Dave Kwiatkowski; Susan Martin; Jenn Nhan; Nicolas Ollberding; David T Selewski; Danielle Soranno; Michelle C Starr; Amy Strong; Sameer Thadani; Huaiyu Zang; Ayse Akcan Arikan; WE-ROCK Collaborative

doi:10.1093/ndt/gfaf067

Functional outcomes in pediatric patients on renal replacement therapy in a worldwide registry

Nephrol Dial Transplant. 2025 Apr 21:gfaf067. doi: 10.1093/ndt/gfaf067. Online ahead of print.

Authors

Kristin J Dolan¹, Katja M Gist², Abby Basalely³, Gabriella Bottari⁴, Abhishek Chakraborty⁵, Mihaela Damian⁶, Dana Fuhrman⁷, Denise C Hasson^{2

8}, Catherine Joseph¹, Dave Kwiatkowski⁶, Susan Martin⁹, Jenn Nhan¹⁰, Nicolas Ollberding², David T Selewski¹¹, Danielle Soranno¹², Michelle C Starr¹², Amy Strong¹³, Sameer Thadani¹, Huaiyu Zang², Ayse Akcan Arikan¹; WE-ROCK Collaborative

Collaborators

WE-ROCK Collaborative:
Emily Ahern, Ayse Akcan Arikan, Issa Alhamoud, Rashid Alobaidi, Pilar Anton-Martin, Shanthi S Balani, Matthew Barhight, Abby Basalely, Amee M Bigelow, Gabriella Bottari, Andrea Cappoli, Eileen A Ciccia, Michaela Collins, Denise Colosimo, Gerard Cortina, Mihaela A Damian, Sara De la Mata Navazo, Gabrielle DeAbreu, Akash Deep, Kathy L Ding, Kristin J Dolan, Sarah N Fernandez Lafever, Dana Y Fuhrman, Ben Gelbart, Katja M Gist, Stephen M Gorga, Francesco Guzzi, Isabella Guzzo, Taiki Haga, Elizabeth Harvey, Denise C Hasson, Taylor Hill-Horowitz, Haleigh Inthavong, Catherine Joseph, Ahmad Kaddourah, Aadil Kakajiwala, Aaron D Kessel, Sarah Korn, Kelli A Krallman, David M Kwiatkowski, Jasmine Lee, Laurance Lequier, Tina Madani Kia, Kenneth E Mah, Eleonora Marinari, Susan D Martin, Shina Menon, Tahagod H Mohamed, Catherine Morgan, Theresa A Mottes, Melissa A Muff-Luett, Siva Namachivayam, Tara M Neumayr, Jennifer Nhan, Abigail O'Rourke, Nicholas J Ollberding, Matthew G Pinto, Dua Qutob, Valeria Raggi, Stephanie Reynaud, Zaccaria Ricci, Zachary A Rumlow, María J Santiago Lozano, Emily See, David T Selewski, Carmela Serpe, Alyssa Serratore, Ananya Shah, Weiwen V Shih, H Stella Shin, Cara L Slagle, Sonia Solomon, Danielle E Soranno, Rachana Srivastava, Natalja L Stanski, Michelle C Starr, Erin K Stenson, Amy E Strong, Susan A Taylor, Sameer V Thadani, Amanda M Uber, Brynna Van Wyk, Tennille N Webb, Huaiyu Zang, Emily E Zangla, Michael Zappitelli

Affiliations

¹ Baylor College of Medicine, Texas Children's Hospital Houston, TX, USA.
² Cincinnati Children's Hospital Medical Center; University of Cincinnati College of Medicine, Cincinnati, OH, USA.
³ Cohen Children's Medical Center, Zucker School of Medicine, Hyde Park, NY, USA.
⁴ Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
⁵ Le Bonheur Children's Hospital, Memphis, TN, US.
⁶ Stanford University School of Medicine Palo Alto, CA, USA.
⁷ University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
⁸ NYU Langone Health, Hassenfeld Children's Hospital, NY, NY, USA.
⁹ Golisano Children's Hospital at University of Rochester Medical Center Rochester, NY, USA.
¹⁰ Children's National Hospital, Washington DC, USA.
¹¹ Medical University of South Carolina, Charleston, SC, USA.
¹² Indiana University School of Medicine, Riley Hospital for Children Indianapolis, IN, USA.
¹³ University of Iowa Stead Family Children's Hospital, Carver College of Medicine Iowa City, IA, USA.

PMID: 40258340
DOI: 10.1093/ndt/gfaf067

Abstract

Background and hypothesis: Mortality rates of children supported with continuous renal replacement therapy (CRRT) have improved, yet morbidity remains high. We aimed to evaluate the functional outcomes of children receiving CRRT using functional status scale (FSS). We hypothesized that children receiving CRRT will have worse FSS compared to their baseline, acquire new morbidity at hospital discharge and 6-and 12-months post discharge, and lack of renal recovery will contribute to worsening functional status.

Methods: This is a retrospective chart review from The Worldwide Exploration of Renal Replacement Outcomes Collaborate in Kidney Disease (WE-ROCK), an international multi-center registry. 28 centers across 5 countries participated in this analysis. Children birth to 25 years, on CRRT for AKI or FO, were included. Patients with underlying kidney disease, on extracorporeal membrane oxygenation, and non-survivors were excluded. FSS was collected at discharge (n = 527), 6 months (n = 387), and 12 months post-discharge (n = 344). The primary outcome was FSS at discharge and 6 months. Secondary outcomes included: new morbidity at discharge and 6 months; FSS at 12 months; and the impact of renal recovery on functional outcomes.

Results: 527 patients had median FSS of 7[6,9] at hospital discharge. 39%(n = 204) had worse FSS. 18%(95/527) acquired a new morbidity at discharge. Predictors of FSS at discharge were baseline FSS(OR 1.30[95% CI 1.11-1.52]), weight(OR 0.99[95% CI 0.98-0.9997]), comorbidities(OR 1.88[95% CI 1.16-3.04]), mechanical ventilation(OR 1.72(95%CI 1.04-2.85]), and sepsis on ICU admission(OR 1.46[95% CI 1.01-2.21]). 387 patients had median FSS score of 6[6,8] at 6 months. 10%(n = 39/387) acquired new morbidity at 6 months. The significant predictors of FSS at 6 months were FSS at discharge(OR 2.36 [95%CI 1.95-2.84]) and presence of comorbidities(OR 1.77[95%CI 1.03-3.06]).

Conclusion: This is the first large, multi-center study evaluating functional outcomes of children on CRRT. Persistent morbidity following discharge emphasizes the importance of comprehensive identification and multidisciplinary follow up to optimize patient outcomes.

Keywords: AKI; dialysis; intensive care; pediatrics; quality of life.