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Background <p>There are limited studies evaluating hyperglycemia in children treated with continuous kidney replacement therapy (CKRT). We evaluated the association of hyperglycemia with kidney outcomes in critically ill children treated with CKRT for acute kidney injury (AKI) or fluid overload.</p> Methods <p>Secondary analysis of the multicenter retrospective observational Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) study (34 centers, 9 countries). Primary exposure was hyperglycemia on days 0–7 of CKRT (average serum glucose of ≥ 150&#xa0;mg/dL). Average serum glucose &lt; 150&#xa0;mg/dL was defined as euglycemic. We stratified the hyperglycemic group with cut-offs ≥ 180&#xa0;mg/dL, ≥ 200&#xa0;mg/dL, or ≥ 250&#xa0;mg/dL. The primary outcome was MAKE-90 (death by 90&#xa0;days or persistent kidney dysfunction [&gt; 125% baseline serum creatinine, or dialysis dependence]).</p> Results <p>Of 985 participants, 48% (473) had average serum glucose &gt; 150&#xa0;mg/dL during days 0–7 of CKRT. There were higher rates of death in the hyperglycemic group (44% vs. 32%, <i>p</i> &lt; 0.001) and longer length of stay among survivors (42 vs. 38&#xa0;days, <i>p</i> = 0.017) compared to the euglycemic group. Those with average glucose ≥ 150&#xa0;mg/dL had higher unadjusted odds of MAKE-90 (OR: 1.36, 95% CI 1.02–1.81); this finding did not remain after multivariate adjustment. Those with average glucose ≥ 180&#xa0;mg/dL had higher adjusted odds of MAKE-90 (aOR: 1.44, 95% CI 1.02–2.04). In adjusted analysis, each 10&#xa0;mg/dL increase in glucose was associated with 3% increased odds of MAKE-90.</p> Conclusions <p>Hyperglycemia is associated with worse kidney outcomes among young persons on CKRT for AKI or fluid overload. Further studies are needed to evaluate the causality and determine appropriate glucose ranges in this high-risk population.</p> Graphical abstract <p></p>

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Hyperglycemia and kidney outcomes in critically ill children and young adults on continuous kidney replacement therapy

  • 期刊论文

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  • 发表日期：

    2025年4月24日

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  • Shrea Goswami,
  • Katja M. Gist,
  • Petter Bjornstad,
  • Eileen Ciccia,
  • Akash Deep,
  • Ben Gelbart,
  • Shina Menon,
  • Eleonora Marinari,
  • Nicholas J. Ollberding,
  • Dua Qutob,
  • JangDong Seo,
  • Danielle E. Soranno,
  • Brynna Van Wyk,
  • Michelle C. Starr,
  • Emily Ahern,
  • Ayse Akcan Arikan,
  • Issa Alhamoud,
  • Rashid Alobaidi,
  • Pilar Anton-Martin,
  • Shanthi S. Balani,
  • Matthew Barhight,
  • Abby Basalely,
  • Amee M. Bigelow,
  • Gabriella Bottari,
  • Andrea Cappoli,
  • Abhishek Chakraborty,
  • Eileen A. Ciccia,
  • Michaela Collins,
  • Denise Colosimo,
  • Gerard Cortina,
  • Mihaela A. Damian,
  • Sara De la Mata Navazo,
  • Gabrielle DeAbreu,
  • Akash Deep,
  • Kathy L. Ding,
  • Kristin J. Dolan,
  • Lama Elbahlawan,
  • Sarah N. Fernandez Lafever,
  • Dana Y. Fuhrman,
  • Ben Gelbart,
  • Katja M. Gist,
  • Stephen M. Gorga,
  • Francesco Guzzi,
  • Isabella Guzzo,
  • Taiki Haga,
  • Elizabeth Harvey,
  • Denise C. Hasson,
  • Taylor Hill-Horowitz,
  • Haleigh Inthavong,
  • Catherine Joseph,
  • Ahmad Kaddourah,
  • Aadil Kakajiwala,
  • Aaron D. Kessel,
  • Sarah Korn,
  • Kelli A. Krallman,
  • David M. Kwiatkowski,
  • Jasmine Lee,
  • Laurance Lequier,
  • Tina Madani Kia,
  • Kenneth E. Mah,
  • Eleonora Marinari,
  • Susan D. Martin,
  • Shina Menon,
  • Tahagod H. Mohamed,
  • Catherine Morgan,
  • Theresa A. Mottes,
  • Melissa A. Muff-Luett,
  • Siva Namachivayam,
  • Tara M. Neumayr,
  • Jennifer Nhan,
  • Abigail O’Rourke,
  • Nicholas J. Ollberding,
  • Matthew G. Pinto,
  • Dua Qutob,
  • Valeria Raggi,
  • Stephanie Reynaud,
  • Zaccaria Ricci,
  • Zachary A. Rumlow,
  • María J. Santiago Lozano,
  • Emily See,
  • David T. Selewski,
  • Carmela Serpe,
  • Alyssa Serratore,
  • Ananya Shah,
  • Weiwen V. Shih,
  • H. Stella Shin,
  • Cara L. Slagle,
  • Sonia Solomon,
  • Danielle E. Soranno,
  • Rachana Srivastava,
  • Natalja L. Stanski,
  • Michelle C. Starr,
  • Erin K. Stenson,
  • Amy E. Strong,
  • Susan A. Taylor,
  • Sameer V. Thadani,
  • Amanda M. Uber,
  • Brynna Van Wyk,
  • Tennille N. Webb,
  • Huaiyu Zang,
  • Emily E. Zangla,
  • Michael Zappitelli

摘要

Background

There are limited studies evaluating hyperglycemia in children treated with continuous kidney replacement therapy (CKRT). We evaluated the association of hyperglycemia with kidney outcomes in critically ill children treated with CKRT for acute kidney injury (AKI) or fluid overload.

Methods

Secondary analysis of the multicenter retrospective observational Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) study (34 centers, 9 countries). Primary exposure was hyperglycemia on days 0–7 of CKRT (average serum glucose of ≥ 150 mg/dL). Average serum glucose < 150 mg/dL was defined as euglycemic. We stratified the hyperglycemic group with cut-offs ≥ 180 mg/dL, ≥ 200 mg/dL, or ≥ 250 mg/dL. The primary outcome was MAKE-90 (death by 90 days or persistent kidney dysfunction [> 125% baseline serum creatinine, or dialysis dependence]).

Results

Of 985 participants, 48% (473) had average serum glucose > 150 mg/dL during days 0–7 of CKRT. There were higher rates of death in the hyperglycemic group (44% vs. 32%, p < 0.001) and longer length of stay among survivors (42 vs. 38 days, p = 0.017) compared to the euglycemic group. Those with average glucose ≥ 150 mg/dL had higher unadjusted odds of MAKE-90 (OR: 1.36, 95% CI 1.02–1.81); this finding did not remain after multivariate adjustment. Those with average glucose ≥ 180 mg/dL had higher adjusted odds of MAKE-90 (aOR: 1.44, 95% CI 1.02–2.04). In adjusted analysis, each 10 mg/dL increase in glucose was associated with 3% increased odds of MAKE-90.

Conclusions

Hyperglycemia is associated with worse kidney outcomes among young persons on CKRT for AKI or fluid overload. Further studies are needed to evaluate the causality and determine appropriate glucose ranges in this high-risk population.

Graphical abstract