Major Adverse Kidney Events in Children Requiring Continuous Kidney Replacement Therapy: A Single-Center Retrospective Study in Japan

Yusuke Tokuda¹Kentaro Ide^1*Junichiro Morota¹Eisaku Nashiki¹Kentaro Nishi²Mai Miyaji³Shotaro Matsumoto¹

• ¹Critical Care Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
• ²Division of Nephrology and Rheumatology, National Center for Child Health and Development (NCCHD), Tokyo, Japan
• ³Pediatric Intensive Care Unit, Department of Pediatrics, St. Marianna University, Kanagawa, Japan

Background: Continuous kidney replacement therapy (CKRT) is an essential supportive therapy for children with acute kidney injury. Nevertheless, a considerable proportion of patients fail to recover kidney function and present with major adverse kidney events (MAKE), a composite outcome including death, dialysis dependence, or persistent kidney dysfunction. Recent international pediatric collaborative studies, mainly from North America, have reported on MAKE following pediatric CKRT. However, such data from Japan remain limited. Methods: We conducted a single-center retrospective study of patients under 16 years of age who received CKRT for renal indications in a tertiary pediatric center between July 2014 and June 2023. The primary outcome was MAKE at 90 days after CKRT initiation (MAKE-90). We used univariate logistic regression analysis to evaluate the association between MAKE-90 and clinical characteristics. Results: Of the 51 eligible patients, 28 (55%) experienced MAKE-90. The components of MAKE-90 were death in 14 patients (27%), dialysis dependence in 10 (20%), and persistent kidney dysfunction in 4 (8%). Univariate logistic regression analysis revealed that CKRT duration (days) (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.00-1.12) and urine output (mL/kg/h) at 14 days after CKRT initiation (OR 0.33, 95% CI 0.14-0.80) were significantly associated with MAKE-90. Conclusion: The incidence of MAKE-90 in our Japanese cohort was over half of the children requiring CKRT, comparable to rates reported in international multicenter studies. Longer CKRT duration and lower urine output on day 14 were associated with MAKE-90, suggesting that these factors may serve as potential prognostic markers.