Outcomes and mortality risk in children with acute kidney injury requiring dialysis and mechanical ventilation: an observational study from a pediatric nephrology critical care unit.

BACKGROUND

AKI in critically ill children on kidney support therapy and mechanical ventilation has high mortality. We aimed to determine outcomes and risk factors for mortality in children with AKI requiring both dialysis and mechanical ventilation in a critical care unit (PN-CCU) managed by pediatric nephrologists.

METHODS

This ambispective observational study recruited children aged 1 month to 18 years admitted with AKI to the PN-CCU who received both dialysis (PD/HD) and mechanical ventilation. Univariable Cox proportional hazards regression was performed to identify predictors of mortality, followed by multivariable Cox regression to adjust for confounding. Model assumptions were tested using Schoenfeld residuals, and Harrell's concordance statistics were used for model fit.

RESULTS

Of 154 children enrolled, 66.9% were male and 60% were < 5 years. Peritoneal dialysis (PD) was predominantly used in this population due to technical constraints limiting haemodialysis (HD). Overall mortality was 52.6%. Mortality was highest in infants (63.8%) who also constituted the largest subgroup, and in those requiring PD alone (59.5%), reflecting late presentation, greater baseline severity and technical constraints that precluded HD. On univariable analysis, elevated lactate, shock, use of ≥ 3 inotropes, high pSOFA scores, emergent intubation in the ER, and non-recovery of AKI were significantly associated with mortality. On multivariable analysis, emergent intubation in ER (HR 4.09, 95% CI 2.33-7.19), non-recovery of AKI (HR 13.10, 95% CI 5.66-30.36), and PD use as the sole dialysis modality (HR 4.58, 95% CI 1.92-10.91) remained independent predictors of mortality.

CONCLUSION

Children with AKI requiring both dialysis (PD/HD) and mechanical ventilation in PN-CCU had a mortality of 52.6%, largely driven by late presentation, severity of illness, and limited access to advanced dialysis modalities.