Major adverse kidney events in children requiring continuous kidney replacement therapy: a single-center retrospective study in Japan

TL;DR

This study examines kidney recovery outcomes in children on kidney replacement therapy in Japan, finding that over half experience major adverse kidney events.

Contribution

The study provides the first detailed Japanese data on MAKE-90 in pediatric CKRT patients and identifies potential prognostic markers.

Findings

55% of children on CKRT experienced major adverse kidney events within 90 days.

Longer CKRT duration and lower urine output on day 14 were significantly associated with adverse outcomes.

Japanese MAKE-90 rates are comparable to international multicenter studies.

Abstract

Continuous kidney replacement therapy (CKRT) is an essential supportive therapy for children with acute kidney injury. Nevertheless, a considerable proportion of patients fail to recover kidney function and present with major adverse kidney events (MAKE), a composite outcome including death, dialysis dependence, or persistent kidney dysfunction. Recent international pediatric collaborative studies, mainly from North America, have reported on MAKE following pediatric CKRT. However, such data from Japan remain limited.

We conducted a single-center retrospective study of patients under 16 years of age who received CKRT for renal indications in a tertiary pediatric center between July 2014 and June 2023. The primary outcome was MAKE at 90 days after CKRT initiation (MAKE-90). We used univariate logistic regression analysis to evaluate the association between MAKE-90 and clinical characteristics.

Of the 51 eligible patients, 28 (55%) experienced MAKE-90. The components of MAKE-90 were death in 14 patients (27%), dialysis dependence in 10 (20%), and persistent kidney dysfunction in 4 (8%). Univariate logistic regression analysis revealed that CKRT duration (days) [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.00–1.12] and urine output (mL/kg/h) at 14 days after CKRT initiation (OR 0.33, 95% CI 0.14–0.80) were significantly associated with MAKE-90.

The incidence of MAKE-90 in our Japanese cohort was over half of the children requiring CKRT, comparable to rates reported in international multicenter studies. Longer CKRT duration and lower urine output on day 14 were associated with MAKE-90, suggesting that these factors may serve as potential prognostic markers.

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