Kidney Week

Abstract: TH-PO079

Infectious Complications in Critically Ill Children and Young Adults Receiving Continuous Kidney Replacement Therapy

Session Information

• AKI: Clinical, Outcomes, and Trials - Epidemiology and Pathophysiology
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Menon, Shina, Stanford University School of Medicine, Stanford, California, United States

Shina Menon, MD, FASN

• Iyer, Sai Prasad N., Seastar Med, Denver, Colorado, United States

Sai Prasad N. Iyer, PhD

• Humes, H. David, University of Michigan Health System, Ann Arbor, Michigan, United States

H. David Humes, MD, DrMed

• Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Stuart Goldstein, MD, FASN

• Damian, Mihaela, Stanford University School of Medicine, Stanford, California, United States

Mihaela Damian, MD, MPH

• Cappoli, Andrea, Ospedale Pediatrico Bambino Gesu, Roma, Italy

Andrea Cappoli, MD

• Joseph, Catherine, Texas Children's Hospital, Houston, Texas, United States

Catherine Joseph, MD

• Soranno, Danielle Elise, Indiana University School of Medicine, Indianapolis, Indiana, United States

Danielle Elise Soranno, MD, FASN

• Starr, Michelle C., Indiana University School of Medicine, Indianapolis, Indiana, United States

Michelle C. Starr, MD, MPH, FASN

• Tolwani, Ashita J., The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States

Ashita J. Tolwani, MD, MS, MSc

• Chung, Kevin K., Seastar Med, Denver, Colorado, United States

Kevin K. Chung, MD

• Mottes, Theresa Ann, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States

Theresa Ann Mottes, APRN, CDN, RN

• Zang, Huaiyu, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Huaiyu Zang, PhD

• Ollberding, Nicholas J., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Nicholas J. Ollberding, MS, PhD

• Gist, Katja M., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Katja M. Gist, DO, MS

Group or Team Name

• Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease.

Background

AKI is known to be associated with subsequent infection. The Regional Citrate vs Systemic Heparin for continuous renal replacement therapy (CRRT) (RICH) study reported higher infection rate in adults treated with regional citrate anticoagulation (RCA) vs heparin (HA). We aimed to determine if RCA was associated with development of infectious complications (positive blood, urine or respiratory culture) in children & young adults after CRRT start.

Methods

We performed 2 secondary analyses using data from Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease. We excluded patients who died < 72 hours of CRRT start, had minor trauma or were post-surgical (n=169) for the first. Additional second analysis exclusions (n=709) were sepsis before CRRT, chronic immunosuppression (organ transplant/immune deficiency). Primary outcome was culture positive infection (blood, urine, respiratory) after CRRT start. Primary predictor was anticoagulation (RCA vs. other).

Results

In the first analysis (n=874) patients, post-CRRT start infection rates were higher for RCA (29%) compared to HA (23%) and others (15%) (p=0.008). Multivariable analysis showed no association between RCA and infection rates (Figure 1A). Second analysis (n=283) patients confirmed no association between RCA and infections in univariable (HA: 94 [33%], RCA: 155 [55%], other: 34 [12%]) or multivariable analyses (Figure 1B).

Conclusion

In this multinational cohort, anticoagulant type was not associated with an increased risk for infection after CRRT start. This is in contrast to the RICH study. Future work will determine if infection after CRRT start worsens outcomes.

Funding

• Commercial Support – Seastar Medical