Major adverse kidney events common among young people undergoing CKRT

Almost two-thirds of youths undergoing continuous kidney replacement therapy (CKRT) have major adverse kidney events 90 days after CKRT initiation (MAKE-90), with risk factors including cardiac comorbidity, time to CKRT initiation, and liberation patterns, according to a study.

The study included 969 children, adolescents, and young adults who were treated with CKRT (median age 8.8 years; 54.6 percent boys). Researchers evaluated clinical characteristics and CKRT parameters. CKRT liberation was classified as successful, reinstituted, or not attempted, with successful liberation defined as the first attempt at CKRT liberation resulting in 72 hours or more of being free of dialysis within 28 days of CKRT initiation.

The main study outcome of MAKE-90, which comprised death or persistent kidney dysfunction (dialysis dependence or ≥25-percent decline in estimated glomerular filtration rate from baseline), occurred in 630 patients (65.0 percent).

On multivariable analysis, predictors of MAKE-90 were cardiac comorbidity (adjusted odds ratio [aOR], 1.60, 95 percent confidence interval [CI], 1.08–2.37), longer duration of intensive care unit admission before CKRT initiation (6 days vs 1 day: aOR, 1.07, 95 percent CI, 1.02–1.13), and liberation pattern.

Of note, successful liberation from CKRT within 28 days was associated with lower odds of MAKE-90 compared with failed liberation (aOR, 0.32, 95 percent CI, 0.22–0.48) and nonattempt of liberation (aOR, 0.02, 95 percent CI, 0.01–0.04).

Future prospective studies are warranted to better understand liberation patterns and practices in relation to the risk of MAKE-90.