Orlando—More than 10 years ago, long duration of continuous renal replacement therapy (CRRT), defined as >4 weeks, was associated with a survival rate that was similar to shorter duration (43% vs 38%), according to a study conducted at Columbia University College of Physicians & Surgeons, New York, New York [Baird JS, Wald EL; Int J Artif Organs, 2010]. During a poster session at the NKF 2017 Spring Clinical Meetings, John Scott Baird, MD, presented follow-up data to the original study. The poster was titled Outcome from Long Duration Continuous Renal Replacement Therapy.
The retrospective case series at the Columbia University Medical Center was approved by the institutional review board and included all pediatric intensive care unit patients who received CRRT from 2008 to 2012. The cohort included eight patients who received long-duration CRRT and 53 who received short-duration CRRT.
Most of the patients (29/53 in the short-duration group and 6/8 in the long-duration group) had an increased risk of mortality, defined as Aspergillosis in an immunocompromised patient, extracorporeal membrane oxygenation, history of stem cell transplant, refractory hemophagocytic lymphohistiocytosis, refractory malignancy, or transplant organ rejection at onset of CRRT. Survival of the patients with an increased risk for mortality was lower than those without an increased mortality risk (P=.03).
Reasons for long-duration CRRT included persistent vasoplegia or capillary leak, persistent hemodynamic instability, or ineligibility for intermittent dialysis. There was no significant difference in survival between the group receiving shorter-duration CRRT and the group receiving longer-duration CRRT (18/53 [34%] vs 2/8 [25%]; P=1).
In conclusion, the researchers said, “CRRT was associated with poor survival in critically ill children with an increased risk of mortality at CRRT onset. However, a longer duration of CRRT did not increase the risk.”
Source: Baird JS. Outcome from long duration continuous renal replacement therapy. Abstract of a poster presented at the National Kidney Foundation 2017 Spring Clinical Meetings, April 19-22, 2017, Orlando, Florida.