Major adverse kidney events at pediatric intensive care unit discharge in a nationwide Japanese pediatric continuous kidney replacement therapy registry.

BACKGROUND

Major adverse kidney events (MAKE)-a composite of death, new dialysis dependence, and persistent kidney dysfunction-are key outcomes in pediatric patients receiving continuous kidney replacement therapy (CKRT). Due to limited Asian pediatric population data, we determined MAKE incidence at pediatric intensive care unit (PICU) discharge and explored associated factors using the first nationwide Japanese pediatric continuous renal replacement therapy (jpCRRT) registry.

METHODS

This cohort study included children (aged < 16 years) who underwent CKRT for acute conditions between 2023 and 2025 in 17 Japanese PICUs. The primary outcome, MAKE at PICU discharge, was defined as death, new dialysis dependence, or persistent kidney dysfunction (≥ 25% increase in serum creatinine from baseline or ≥ 25% decrease in estimated glomerular filtration rate). Multivariable logistic regression, with variable selection using the least absolute shrinkage and selection operator and adjustment for clinically relevant covariates, was used to identify independent predictors of MAKE.

RESULTS

Of 139 patients, 76 (54.7%) developed MAKE, comprising death, new dialysis dependence, and persistent kidney dysfunction in 25 (18.0%), 18 (13.0%), and 33 (23.7%), respectively. Independent MAKE factors were primary admission diagnoses of kidney disease (adjusted odds ratio (AOR), 60.7; 95% confidence interval (CI), 5.8-639), infection/sepsis (AOR, 37.0; 95% CI, 3.7-373), higher vasoactive-inotropic score (per 1-point increase; AOR, 1.04; 95% CI, 1.004-1.08), and hyperkalemia (per 1 mmol/L increase; AOR, 2.0; 95% CI, 1.1-3.6). High vasoactive support and hyperkalemia were associated with mortality, whereas kidney and infectious admission diagnoses were associated with new dialysis dependence or persistent kidney dysfunction.

CONCLUSION

Among children receiving CKRT, more than half experienced MAKE at PICU discharge. Notably, a primary admission diagnosis of kidney disease was associated with adverse short-term outcomes, along with infectious/septic admission diagnoses, higher vasoactive-inotropic scores, and hyperkalemia. Longer-term follow-up is needed to clarify subsequent kidney recovery and post-discharge outcomes.