1. The Association Between Vasopressin and Adverse Kidney Outcomes in Children and Young Adults Requiring Vasopressors on Continuous Renal Replacement Therapy
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Denise C. Hasson, MD, Katja M. Gist, DO, MSc, JangDong Seo, PhD, Erin K. Stenson, MD, Aaron Kessel, MD, MS, Taiki Haga, MD, MSc, Sara LaFever, MD, PhD, Maria Jose Santiago, MD, PhD, Matthew Barhight, MD, MS, David Selewski, MD, MSCR, Zaccaria Ricci, MD, Nicholas J. Ollberding, PhD, Natalja L. Stanski, MD, on behalf of the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) Collaborative, Emily Ahern, CPNP, DNP, Ayse Akcan Arikan, MD, Issa Alhamoud, MD, Rashid Alobaidi, MD, MSc, Pilar Anton-Martin, MD, PhD, Shanthi S. Balani, MD, Abby Basalely, MD, MS, Amee M. Bigelow, MD, MS, Gabriella Bottari, MD, Andrea Cappoli, MD, Eileen A. Ciccia, MD, Michaela Collins, BA, Denise Colosimo, MD, Gerard Cortina, MD, Mihaela A. Damian, MD, MPH, Sara De la Mata Navazo, MD, Gabrielle DeAbreu, MD, Akash Deep, MD, Kathy L. Ding, BS, Kristin J. Dolan, MD, Sarah N. Fernandez Lafever, MD, PhD, Dana Y. Fuhrman, DO, MS, Ben Gelbart, MBBS, Stephen M. Gorga, MD, MSc, Francesco Guzzi, MD, Isabella Guzzo, MD, Taiki Haga, MD, Elizabeth Harvey, MD, Taylor Hill-Horowitz, BS, Haleigh Inthavong, BS, MS, Catherine Joseph, MD, Ahmad Kaddourah, MD, MS, Aadil Kakajiwala, MD, MSCI, Aaron D. Kessel, MD, MS, Sarah Korn, DO, Kelli A. Krallman, BSN, MS, David M. Kwiatkowski, MD, Msc, Jasmine Lee, MSc, Laurance Lequier, MD, Tina Madani Kia, BS, Kenneth E. Mah, MD, MS, Eleonora Marinari, MD, Susan D. Martin, MD, Shina Menon, MD, Tahagod H. Mohamed, MD, Catherine Morgan, MD, MSc, Theresa A. Mottes, APRN, Melissa A. Muff-Luett, MD, Siva Namachivayam, MBBS, Tara M. Neumayr, MD, Jennifer Nhan Md, MS, Abigail O’Rourke, MD, Matthew G. Pinto, MD, Dua Qutob, MD, Valeria Raggi, MD, Stephanie Reynaud, MD, Zachary A. Rumlow, DO, María J. Santiago Lozano, MD, PhD, Emily See, MBBS, David T. Selewski, MD, MSCR, Carmela Serpe, MSc, PhD, Alyssa Serratore, RN, MsC, Ananya Shah, BS, Weiwen V. Shih, MD, H. Stella Shin, MD, Cara L. Slagle, MD, Sonia Solomon, DO, Danielle E. Soranno, MD, Rachana Srivastava, MD, Michelle C. Starr, MD, MPH, Amy E. Strong, MD, MSCE, Susan A. Taylor, MSc, Sameer V. Thadani, MD, Amanda M. Uber, DO, Brynna Van Wyk, ARNP, MSN, Tennille N. Webb, MD, MSPH, Huaiyu Zang, PhD, Emily E. Zangla, DO, Michael Zappitelli, MD, MSc, T. Christine, E. Alvarez, MHI, RN, Elizabeth Bixler, BS, Erica Blender Brown, MA, CRA, Cheryl L. Brown, BS, Ambra Burrell, BA, Anwesh Dash, BS, Jennifer L. Ehrlich, RN, MHA, Simrandeep Farma, HBSc, Kim Gahring, RN, BSN, CCRN, Barbara Gales, RN, Madison R. Hilgenkamp, Sonal Jain, MS, Kate Kanwar, BA, MS, Jennifer Lusk, BSN, RN, CCRN, Christopher J. Meyer, BA AA, Katherine Plomaritas, BSN, RN, Joshua Porter, BS, Jessica Potts, BSN, RN, Alyssa Serratore, BNurs, GDipNP(PIC), RN, MsC, Elizabeth Schneider, BS, Vidushi Sinha, BS, P. J. Strack, RN, BSN, CCRN, Sue Taylor, RN, Katherine Twombley, MD, Brynna Van Wyk, MSN, ARNP, CPNP, Samantha Wallace, MS, Janet Wang, BS, Megan Woods, BS, Marcia Zinger, RN, and Alison Zong, BS
- Subjects
Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
OBJECTIVES:. Continuous renal replacement therapy (CRRT) and shock are both associated with high morbidity and mortality in the ICU. Adult data suggest renoprotective effects of vasopressin vs. catecholamines (norepinephrine and epinephrine). We aimed to determine whether vasopressin use during CRRT was associated with improved kidney outcomes in children and young adults. DESIGN:. Secondary analysis of Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK), a multicenter, retrospective cohort study. SETTING:. Neonatal, cardiac, PICUs at 34 centers internationally from January 1, 2015, to December 31, 2021. PATIENTS/SUBJECTS:. Patients younger than 25 years receiving CRRT for acute kidney injury and/or fluid overload and requiring vasopressors. Patients receiving vasopressin were compared with patients receiving only norepinephrine/epinephrine. The impact of timing of vasopressin relative to CRRT start was assessed by categorizing patients as: early (on or before day 0), intermediate (days 1–2), and late (days 3–7). INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Of 1016 patients, 665 (65%) required vasopressors in the first week of CRRT. Of 665, 248 (37%) received vasopressin, 473 (71%) experienced Major Adverse Kidney Events at 90 days (MAKE-90) (death, renal replacement therapy dependence, and/or > 125% increase in serum creatinine from baseline 90 days from CRRT initiation), and 195 (29%) liberated from CRRT on the first attempt within 28 days. Receipt of vasopressin was associated with higher odds of MAKE-90 (adjusted odds ratio [aOR], 1.80; 95% CI, 1.20–2.71; p = 0.005) but not liberation success. In the vasopressin group, intermediate/late initiation was associated with higher odds of MAKE-90 (aOR, 2.67; 95% CI, 1.17–6.11; p = 0.02) compared with early initiation. CONCLUSIONS:. Nearly two-thirds of children and young adults receiving CRRT required vasopressors, including over one-third who received vasopressin. Receipt of vasopressin was associated with more MAKE-90, although earlier initiation in those who received it appears beneficial. Prospective studies are needed to understand the appropriate timing, dose, and subpopulation for use of vasopressin.
- Published
- 2024
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