Patient-centered outcomes in pediatric continuous kidney replacement therapy: new morbidity and worsened functional status in survivors
| العنوان: | Patient-centered outcomes in pediatric continuous kidney replacement therapy: new morbidity and worsened functional status in survivors |
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| المؤلفون: | Jeanine M. Graf, Cynthia S. Bell, Mallory Smith, Ayse Akcan Arikan, Laura Loftis, Molly Wong Vega, Mona L. McPherson, Naile Tufan Pekkucuksen |
| المصدر: | Pediatric Nephrology (Berlin, Germany) |
| بيانات النشر: | Springer Science and Business Media LLC, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | medicine.medical_specialty, CKRT, medicine.medical_treatment, Sedation, Population, AKI, Patient-Centered Care, medicine, Humans, Survivors, Risk factor, Child, education, Children, Dialysis, Retrospective Studies, education.field_of_study, business.industry, Mortality rate, Patient-centered outcomes, Functional status, Retrospective cohort study, medicine.disease, Comorbidity, Renal Replacement Therapy, Treatment Outcome, Nephrology, ICU, Pediatrics, Perinatology and Child Health, Emergency medicine, Original Article, Morbidity, medicine.symptom, business |
| الوصف: | Background Ongoing measures to improve pediatric continuous kidney replacement therapy (CKRT) have lowered mortality rates, shifting the focus to survivor functional status. While septic acute kidney injury generates new morbidity in pediatric critically ill patients, acquired morbidities and functional status of CKRT population are unknown. We predicted that CKRT survivors are at risk for new morbidity and would have worse functional status at PICU discharge compared to baseline, and aimed to describe associated factors. Methods Retrospective cohort study over 24 months of CKRT patients surviving to PICU discharge in a quaternary children’s hospital. Functional outcome was determined by Functional Status Scale (FSS). Results FSS scores were higher at PICU and hospital discharge compared to baseline. Of 45 CKRT survivors, 31 (69%) had worse FSS score at PICU discharge and 51% had new morbidity (≥3 increase in FSS); majority qualified as moderate to severe disability (FSS ≥10). Four patients (9%) had new tracheostomy, 3 (7%) were ventilator dependent, and 10 (22%) were dialysis dependent. Most (23/45, 51%) required outpatient rehabilitation. Cumulative days on sedation, controlled for illness severity, were independently associated with worse FSS at PICU discharge (aOR 25.18 (3.73, 169.92)). In adjusted analyses, duration of sedation was associated with new morbidity, while neurologic comorbidity, percent fluid overload at CKRT start, and nonrenal comorbidity were associated with moderate to severe disability at PICU discharge when controlled for baseline FSS. Conclusions CKRT survivors, with new morbidity and worse functional outcomes at PICU discharge, are a newly described vulnerable population requiring targeted follow-up. Deliberate decrease of sedation exposure in patients with decreased clearance due to organ dysfunction needs to be studied as a modifiable risk factor. Supplementary Information The online version contains supplementary material available at 10.1007/s00467-021-05177-7. |
| تدمد: | 1432-198X 0931-041X |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1a906ede1f4f0eb058175bb87ff5b21a https://doi.org/10.1007/s00467-021-05177-7 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....1a906ede1f4f0eb058175bb87ff5b21a |
| قاعدة البيانات: | OpenAIRE |
Find this article in full text from Springer Verlag. | تدمد: | 1432198X 0931041X |
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