Hyperglycemia and kidney outcomes in critically ill children and young adults on continuous kidney replacement therapy

TL;DR

High blood sugar in children on kidney therapy is linked to worse kidney outcomes and higher death rates.

Contribution

This study identifies hyperglycemia as a risk factor for poor kidney outcomes in critically ill children on CKRT.

Findings

Hyperglycemia was associated with higher death rates and longer hospital stays in children on CKRT.

Each 10 mg/dL increase in glucose was linked to a 3% higher risk of poor kidney outcomes.

Hyperglycemia at ≥180 mg/dL showed a significant adjusted risk for MAKE-90 outcomes.

Abstract

There are limited studies evaluating hyperglycemia in children treated with continuous kidney replacement therapy (CKRT). We evaluated the association of hyperglycemia with kidney outcomes in critically ill children treated with CKRT for acute kidney injury (AKI) or fluid overload.

Secondary analysis of the multicenter retrospective observational Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) study (34 centers, 9 countries). Primary exposure was hyperglycemia on days 0–7 of CKRT (average serum glucose of ≥ 150 mg/dL). Average serum glucose < 150 mg/dL was defined as euglycemic. We stratified the hyperglycemic group with cut-offs ≥ 180 mg/dL, ≥ 200 mg/dL, or ≥ 250 mg/dL. The primary outcome was MAKE-90 (death by 90 days or persistent kidney dysfunction [> 125% baseline serum creatinine, or dialysis dependence]).

Of 985 participants, 48% (473) had average serum glucose > 150 mg/dL during days 0–7 of CKRT. There were higher rates of death in the hyperglycemic group (44% vs. 32%, p < 0.001) and longer length of stay among survivors (42 vs. 38 days, p = 0.017) compared to the euglycemic group. Those with average glucose ≥ 150 mg/dL had higher unadjusted odds of MAKE-90 (OR: 1.36, 95% CI 1.02–1.81); this finding did not remain after multivariate adjustment. Those with average glucose ≥ 180 mg/dL had higher adjusted odds of MAKE-90 (aOR: 1.44, 95% CI 1.02–2.04). In adjusted analysis, each 10 mg/dL increase in glucose was associated with 3% increased odds of MAKE-90.

Hyperglycemia is associated with worse kidney outcomes among young persons on CKRT for AKI or fluid overload. Further studies are needed to evaluate the causality and determine appropriate glucose ranges in this high-risk population.

A higher resolution version of the Graphical abstract is available as Supplementary information

A higher resolution version of the Graphical abstract is available as Supplementary information

The online version contains supplementary material available at 10.1007/s00467-025-06777-3.

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