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- Title
Outcomes associated with the use of renal replacement therapy in children receiving extracorporeal membrane oxygenation after heart surgery: a multi-institutional analysis.
- Authors
Gupta, Punkaj; Beam, Brandon; Schmitz, Michael
- Abstract
Background: The primary objective of this investigation was to study the association between renal replacement therapy (RRT) and outcomes in children receiving extracorporeal membrane oxygenation (ECMO). Methods: Patients aged ≤18 years receiving ECMO before or after a pediatric heart operation at a Pediatric Health Information System (PHIS)-participating hospital (2004-2013) were included. The associations between RRT and study outcomes were computed using multivariate logistic regression analysis. Results: A total of 3,502 patients from 43 hospitals qualified for inclusion. Of these, 484 (14 %) patients received RRT at some point during their hospital stay. After adjusting for patient and center characteristics, the odds of mortality were significantly higher in the RRT group (OR: 1.86, 95 % CI: 1.46- 2.37, p < 0.0001). However, there were considerable reductions in adjusted odds of mortality, compared to unadjusted odds of mortality. In adjusted models, length of ECMO was longer by 0.81 days (95 % CI: 0.13- 1.49, p = 0.02) in patients receiving RRT. Conclusions: We demonstrated worsening outcomes in children receiving ECMO with RRT compared to children receiving ECMO without RRT. Although the results could reflect confounding by severity of illness, they provide a rationale for prospective testing of use of RRT in critically ill children receiving ECMO with heart surgery.
- Subjects
UNITED States; TREATMENT of acute kidney failure; MORTALITY risk factors; ACUTE kidney failure; CHI-squared test; CONFIDENCE intervals; EXTRACORPOREAL membrane oxygenation; HEART diseases; CARDIAC surgery; KIDNEY diseases; EVALUATION of medical care; MEDICAL cooperation; PEDIATRICS; RESEARCH; STATISTICS; THERAPEUTICS; DATA analysis; MULTIPLE regression analysis; RETROSPECTIVE studies; DATA analysis software; DESCRIPTIVE statistics; ODDS ratio; DISEASE complications
- Publication
Pediatric Nephrology, 2015, Vol 30, Issue 6, p1019
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-014-3025-y