Outcomes of continuous kidney replacement therapy in pediatric patients: The impact of timing and predictors of mortality

Outcomes of continuous kidney replacement therapy in pediatric patients: The impact of timing and predictors of mortality | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Outcomes of continuous kidney replacement therapy in pediatric patients: The impact of timing and predictors of mortality Abdulsalam S Alrashdi, Jaser N Alshammari, Sulaiman K Abdullah, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5726801/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 May, 2025 Read the published version in Pediatric Nephrology → Version 1 posted 5 You are reading this latest preprint version Abstract Background While critically ill children receiving continuous kidney replacement therapy (CKRT) are at increased risk of mortality, few studies have examined the predictors of mortality in this population. This study aimed to evaluate CKRT outcomes, focusing on predictors of mortality. Methods This cohort study included children aged 0–14 years who received CKRT. It collected baseline, clinical, and laboratory data. Descriptive analyses were performed. Least absolute shrinkage and selection operator (LASSO) regression was used to select the best predictors of mortality. A multivariable logistic regression model was constructed and validated with 1000 bootstraps. Results This study included 113 children who received CKRT, of whom 83 (73.5%) survived and 30 (26.6%) died. Children admitted to the intensive care unit with a higher Pediatric Risk of Mortality III score, sepsis, longer intubation, or hypoalbuminemia (< 30 g/dL) were more likely to die. Multifactorial acute kidney injury was more common in those who died than in those who survived (83.3% vs. 31.3%, p < 0.01). As the exclusive indication for CKRT, fluid overload was more common in those who died than in those who survived (26.7% vs. 6.0%, p = 0.01). LASSO and multivariable regression models identified hemodynamic instability, as evidenced by inotropic support use, and abnormal coagulation, as evidenced by not using anticoagulation, as independent predictors of morality. Initiating CKRT late (> 48 hours) was associated with mortality in the univariate but not the multivariate analysis. Conclusion Hemodynamic instability was the best predictor of mortality in critically ill children receiving CKRT. Acute kidney injury Continuous kidney replacement therapy (CKRT) Critically ill children Pediatrics Mortality. Figures Figure 1 Introduction Acute kidney injury (AKI) is recognized as a predictor of worse outcomes in critically ill pediatric patients [ 1 ]. AKI is often multifactorial, with sepsis, respiratory failure, congenital heart disease, and nephrotoxic medication use involved in its pathogenesis [ 2 – 3 ]. AKI increases mortality sixfold, even after adjustment for baseline characteristics [ 4 ]. Continuous kidney replacement therapy (CKRT) could improve AKI outcomes by correcting metabolic disturbances and fluid removal while maintaining hemodynamic stability [ 1 , 5 ]. While the predictors of CKRT outcomes remain controversial, several studies identified anticoagulant use, CKRT dosing, and the timing of CKRT initiation as significant determinants [ 3 , 6 ]. Several studies have hypothesized that early initiation of CKRT is associated with preferable outcomes [ 7 – 8 ]. However, two systematic reviews assessing the timing of CKRT initiation on outcomes in adults found that early initiation did not significantly reduce mortality despite decreased metabolic acidosis development, in addition to three adult randomized controlled trials demonstrating insignificant effects [ 9 – 13 ]. A retrospective pediatric cohort study showed better outcomes with early CKRT initiation. However, the Prospective Pediatric Continuous Renal Replacement Therapy (ppCRRT) registry reported higher mortality in pediatric patients weighing < 10 kg, resulting in a debatable statement in the timing of CKRT initiation [ 14 ]. Therefore, this study aimed to assess CKRT outcomes in a heterogeneous group of critically ill pediatric patients, focusing on predictors of mortality and the impact of the timing of CKRT initiation. Methods Study population, period, and design This retrospective cohort study reviewed the medical records of all pediatric patients admitted to the intensive care unit (ICU) at King Fahad Medical City—a tertiary care center in Riyadh, Saudi Arabia—who received inpatient CKRT between 2007 and 2021. AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes definition [ 15 ]. Patients on chronic dialysis or with insufficient data were excluded. The treating physicians determined CKRT initiation according to local policy. Exposures and outcomes Patients’ demographic characteristics were collected from their medical records, including age, sex, nationality, and anthropometric measurements. Their clinical data were also collected, including baseline clinical and laboratory characteristics at ICU admission and CKRT initiation. Pediatric Risk of Mortality (PRISM) III score was also documented. The examined CKRT characteristics were therapy duration (days), number of sessions, vascular access, catheter size, CKRT mode (continuous veno-venous hemodialysis [CVVHD], continuous veno-venous hemofiltration [CVVH], or continuous hemodiafiltration [CVVHDF]), CKRT dose (mL/kg/session), blood flow rate (mL/min), and anticoagulation use. The primary outcome was in-hospital mortality. Fluid overload was defined as a ≥ 10% increase in total body water, determined by fluid balance and body weight at ICU admission, ideal body weight, or clinical evidence of water retention. Fluid balance was determined by subtracting the present weight from the admission weight and dividing the result by the admission weight. Ethical considerations This study received ethical approval from the King Fahad Medical City institutional review board (committee registration H-01-R-012/IRB00010470; Study approval FWA00018774). Statistical analysis The data were collected using Microsoft Excel 365 (Seattle, WA, USA). The demographic and clinical data were descriptively summarized as medians (interquartile ranges [IQRs]) for continuous variables and numbers (percentages) for categorical variables. Variables were compared between patients who survived and died using the Mann–Whitney U test for continuous variables and the chi-square or Fisher’s exact test for categorical variables. Continuous variables with clinically known categories, such as albumin level, are presented as both continuous and categorical variables. A p -value < 0.05 was considered statistically significant. The best predictors of mortality were identified using least absolute shrinkage and selection operator (LASSO) regression, which included all variables that were significant in the descriptive analysis screening. The LASSO regression was tenfold cross-validated to select the optimal regularization parameter (λ) and prevent overfitting; λ was selected within one standard error of the minimum mean squared prediction error. Then, the selected variables underwent multivariable logistic regression. The odds ratio (OR) and its 95% confidence interval (CI) and p -value are reported for each variable in this model. Lastly, given the relatively small sample size, the stability and generalizability of this logistic regression model were assessed using bootstrap validation with 1000 replicates. The statistical analyses were performed using the STATA statistical software (version 15.1; StataCorp, College Station, TX, USA). Results This study enrolled 113 pediatric patients who met the eligibility criteria (Table 1 ), of whom 83 (73.5%) survived and 30 (26.6%) died. Among participants, over half were male ( n = 45, 54.2%), and the median age was 24 (9–132) months, with nearly two-thirds (65.5%) aged over one year. In addition, their median height was 86 (62–134) cm. Notably, body weights were significantly higher in the survived group (median = 14.0 [8.5–30.5] kg) than in the deceased group (median = 7.7 [3.7–27.0] kg; p = 0.03). Table 1 Baseline characteristics of the pediatric patients who received CKRT. Total ( N = 113) Survived ( n = 83, 73.5%) Deceased ( n = 30, 26.6%) p -value Demographic characteristic Sex, male (n [%]) 61 (54) 45 (54.2) 16 (53.3) 0.93 Age, months (median [IQR]) 24 (9–132) 24 (12–132) 24 (1.6–132) 0.28 Age category Neonates ( 12 mo) 14 (12.4) 7 (8.4) 7 (23.3) 0.12 25 (22.1) 19 (22.9) 6 (20) 74 (65.5) 57 (68.7) 17 (56.7) Weight, kg (median [IQR]) 13 (6.6–30) 14 (8.5–30.5) 7.7 (3.7–27) 0.03 Height, cm (median [IQR]) 86 (62–134) 93 (70–135) 78 (52–134) 0.24 Baseline clinical characteristics at ICU admission PRISM III Score, (median [IQR]) 8 (4–14) 7 (3–13) 10 (8–16) < 0.01 Sepsis Admission, (n [%]) 43 (38.1) 19 (22.9) 24 (80) < 0.01 Intubation, (n [%]) 71 (62.8) 43 (51.8) 28 (93.3) < 0.01 Ventilation duration, days (median [IQR]) 4 (0–14) 1 (0–7) 17.5 (11–34) < 0.01 Laboratories Serum creatinine, µmol/L (median [IQR]) 152 (54–467) 260 (87–623) 46 (34–119) < 0.01 BUN, mmol/L (median [IQR]) 14.7 (5–29.9) 21 (9.9–35) 5 (3.7–8.4) < 0.01 Potassium, mmol/L (median [IQR]) 4 (3.5–4.8) 4 (3.5–4.8) 4.3 (3.6–4.9) 0.95 Sodium, mmol/L (median [IQR]) 137 (133–141) 136 (133–141) 138.5 (134–141) 0.51 Albumin, g/dL (median [IQR]) 26.1 (22–31) 27 (22.5–32) 25.7 (19.7–29) 0.12 Albumin categories < 30 g/dL, (n [%]) ≥ 30 g/dL, (n [%]) 76 (67.3) 51 (61.5) 25 (83.3) 0.04 37 (32.7) 32 (38.6) 5 (16.7) At ICU admission, PRISM III scores were significantly higher in the deceased group (median = 10 [ 8 – 16 ]) than in the survived group (median = 7 [ 3 – 13 ]; p < 0.01). In addition, admission due to sepsis was significantly more common in the deceased group ( n = 24, 80%) than in the survived group ( n = 19, 22.9%; p < 0.01), consistent with the significantly higher intubation rate in the deceased group (93.3%) than in the survived group (51.8%; p < 0.01) and the significantly longer ventilation periods in the deceased group (median = 17.5 [ 11 – 34 ] days) than in the survived group (median = 1 [0–7] day; p < 0.01). The laboratory results at ICU admission showed significant differences between the survived and decreased groups for serum creatinine (median = 260 [87–623] vs. 46 [34–119] µmol/L) and blood urea nitrogen (BUN; median = 21 [9.9–35.] vs. 5 [3.7–8.4] mmol/L; p < 0.01). Moreover, hypoalbuminemia was significantly more common in the deceased group ( n = 25, 83.3%) than in the survived group ( n = 51, 61.5%; p = 0.04). Multifactorial AKI was more common in the deceased group ( n = 25, 83.3%) than in the survived group ( n = 26, 31.3%; p < 0.01). The primary indication for CKRT was fluid overload, which was more common in the deceased group ( n = 8, 26.7%) than in the survived group ( n = 5, 6%; p = 0.01). The ICU stay length before CKRT initiation was higher in the deceased group (median = 7 [ 3 – 14 ] days) than in the survived group (median = 1 [ 1 – 1 ] days; p < 0.01). More patients required inotropic support in the decreased group ( n = 28, 93.3%) than in the survived group ( n = 15, 18.1%; p < 0.01; Table 2 ). Table 2 Clinical characteristics at CKRT initiation and CKRT prescription information. Total ( N = 113) Survived ( n = 83, 73.5%) Deceased ( n = 30, 26.6%) p -value Baseline clinical characteristics at CKRT initiation Cause of AKI Multifactorial, (n [%]) Septic shock, (n [%]) Kidney disease, (n [%]) No acute kidney disease, (n [%]) 51 (45.1) 26 (31.3) 25 (83.3) < 0.01 4 (3.5) 4 (4.8) 0 (0) 44 (38.9) 41 (49.4) 3 (10) 14 (12.4) 12 (14.5) 2 (6.7) Indication for CKRT Fluid overload & electrolyte imbalance, (n [%]) Fluid overload only, (n [%]) Electrolyte imbalance only, (n [%]) 70 (62) 53 (63.9) 17 (56.7) 0.01 13 (11.5) 5 (6) 8 (26.7) 30 (26.6) 25 (30.1) 5 (16.7) Days in ICU prior to CKRT, (median [IQR]) 1 (1–5) 1 (1–1) 7 (3–14) < 0.01 Duration prior to CKRT Less than 48 hrs., (n [%]) More than 48 hrs., (n [%]) 76 (67.3) 69 (83.1) 7 (23.3) < 0.01 37 (32.7) 14 (16.9) 23 (76.7) Fluid overload, (median [IQR]) 10% (5–12%) 10% (0–14%) 10% (6–10%) 0.99 PRISM III score, (median [IQR]) 11 (5–17) 8 (4–14) 19 (14–25) < 0.01 Inotropic support, (n [%]) 43 (38.1) 15 (18.1) 28 (93.3) < 0.01 Number of inotropic agents None, (n [%]) 1 agent, (n [%]) ≥ 2 agents, (n [%]) 70 (62) 68 (81.9) 2 (6.7) < 0.01 19 (16.8) 10 (12.1) 9 (30) 24 (21.1) 5 (6) 19 (63.3) Diuretic use, (n [%]) 94 (83.2) 68 (81.9) 26 (86.7) 0.78 Urine output, ml/kg/hr (median [IQR]) 1 (0.3–2) 0.9 (0.2–2) 1.2 (0.6–1.9) 0.23 Laboratories Serum creatinine, µmol/L (median [IQR]) 192 (84–467) 260 (116–623) 84 (61–192) < 0.01 BUN, mmol/L (median [IQR]) 15.3 (9–30.8) 21 (10.5–38.5) 10 (4.3–14.7) < 0.01 Potassium, mmol/L (median [IQR]) 4 (3.6–4.7) 3.9 (3.5–4.6) 4.3 (3.9–4.7) 0.11 Sodium, mmol/L (median [IQR]) 137 (134–142) 136 (133–142) 138.5 (136–144) 0.16 Albumin, g/dL (median [IQR]) 26 (22.5–31) 26 (22.5–31.3) 25.2 (21–28.2) 0.20 Table 3 CKRT prescription characteristics. Total ( N = 113) Survived ( n = 83, 73.5%) Deceased ( n = 30, 26.6%) p -value CKRT prescription CKRT duration, days (median [IQR]) 7 (3–11) 6 (3–10) 12 (2–22) 0.14 CKRT sessions Less than 10 sessions, (n [%]) More than 10 sessions, (n [%]) 82 (72.6) 68 (81.9) 14 (46.7) < 0.01 31 (27.4) 15 (18.1) 16 (53.3) Vascular access Femoral, (n [%]) Internal jugular, (n [%]) Subclavian, (n [%]) External jugular, (n [%]) 47 (41.6) 39 (46.9) 8 (26.7) 0.09 62 (54.9) 40 (48.2) 22 (73.3) 3 (2.7) 3 (3.6) 0 (0) 1 (0.9) 1 (1.2) 0 (0) CKRT catheter size, (median [IQR]) 3 (2–6) 3 (2–6) 2 (2–5) 0.26 CKRT mode CVVHD, (n [%]) CVVH, (n [%]) CVVHDF, (n [%]) 29 (25.7) 28 (33.7) 1 (3.3) 50 mL/kg/h, (n [%]) 73 (64.6) 60 (72.3) 13 (43.3) < 0.01 40 (35.4) 23 (27.7) 17 (56.7) Blood flow rate (average/pat), mL/min (median [IQR]) 2 (2–4) 3 (2–4) 2 (1–5) 0.09 Anticoagulation Heparin, (n [%]) No anticoagulation, (n [%]) 69 (61.1) 63 (75.9) 6 (20) < 0.01 44 (38.9) 20 (24.1) 24 (80) CKRT duration did not differ significantly between the survived group (median = 6 [ 3 – 10 ] days) and the deceased group (median = 12 [ 11 – 34 ] days; p = 0.14). In contrast, significantly more patients underwent more than 10 CKRT sessions in the deceased group (53.3%) than in the survived group (18.3%; p < 0.01). The CVVH mode was used more often in the deceased group (96.7%) than in the survived group (60.2%; p < 0.01) while CCVHD was more frequent in the survived group (33.7%; p < 0.01) and less frequent of CVVHD use in overall (4.4%). The CKRT dose and anticoagulation use differed significantly between groups, with 72.3% of the survived group and 43.3% of the deceased group receiving < 50 mL/kg/h ( p < 0.01) and 75.9% of the survived group and 20% of the deceased group receiving heparin ( p < 0.01). Using cross-validated LASSO regression of all variables differing significantly between the deceased and survived groups, the following variables were identified as predicting mortality: sepsis at ICU admission, PRISM III score at CKRT initiation, inotropic support at CKRT initiation, not using anticoagulation during CKRT, and CKRT initiation of > 48 hours after ICU admission. These variables were then combined in a multivariable regression model, which showed that patients receiving inotropic support at CKRT initiation had a significantly higher risk of mortality (adjusted OR [aOR] = 15.068, 95% CI = 2.487–91.306; Table 4 ). This association remained significant after bootstrap validation (OR = 15.068, 95% CI = 1.059–214.414). Additionally, no anticoagulant use during CKRT was associated with an increased risk of mortality (aOR = 4.699, 95% CI = 1.156–19.104); however, this association was not significant after bootstrap validation (OR = 4.699, 95% CI = 0.591–37.379). No significant associations were found between mortality and sepsis at ICU admission, PRISM III score at CKRT initiation, or CKRT initiation > 48 hours after ICU admission ( p > 0.05). Table 4 The process of identifying the most predictive features, including cross-validated LASSO regression with tenfold cross-validation, followed by multivariable logistic regression of the identified features and bootstrap validation with 1000 replications. Features selected using Cross-validated LASSO regression* Multivariable logistic regression Bootstrap validation (1000 replications) aOR 95% CI p -value aOR 95% CI p -value Sepsis on admission to ICU 1.700 0.372 7.761 0.494 1.700 0.247 11.713 0.590 PRISM III Score at CKRT initiation 1.060 0.969 1.159 0.205 1.060 0.935 1.201 0.363 Inotropic support at CKRT initiation 15.068 2.487 91.306 0.003 15.068 1.059 214.414 0.045 Anticoagulation in CKRT (none) 4.699 1.156 19.104 0.031 4.699 0.591 37.379 0.144 CKRT initiation > 48 hours of ICU admission 3.023 0.726 12.578 0.128 3.023 0.273 33.479 0.367 *Optimal λ for LASSO (22.37) was selected within one standard error of the minimum mean squared prediction error. LASSO, least absolute shrinkage and selection operator; aOR, adjusted odds ratio. Discussion This cohort study conducted at a tertiary care hospital observed that critically ill pediatric patients undergoing CKRT had a mortality rate of 26.6%. The identified independent predictors of mortality included inotropic support at CKRT initiation and CKRT without anticoagulation use, which could represent hemodynamic instability and disordered coagulation, respectively. The LASSO regression model identified later CKRT initiation (> 48 hours), sepsis at ICU admission, and higher PRISM III scores at CKRT initiation as predictors of mortality; however, they were not independently associated with mortality in the multivariable model. The need for inotropic support indicates a significant condition that influences CKRT outcomes [ 16 – 17 ]. It could reflect a hemodynamic compromise with low cardiac output and organ failures [ 18 – 20 ]. Lavefer et al. suggested that CKRT stabilizes the hemodynamic status through various mechanisms, including removing excess fluids and reducing body temperature, which may help in the inotropic support context [ 21 ]. This notion is supported by their observation of an initial drop in blood pressure followed by a reversal within the next 15 minutes. In contrast, a single-center retrospective cohort study found that only heart rate decreased and normalized while hypotension events remained escalating alongside the vasoactive inotropic score (VIS) [ 22 ]. While the VIS is an independent predictor of mortality in pediatric patients with sepsis [ 23 ], it was not significantly associated with survival in infants undergoing CKRT [ 24 ]. Notably, while the VIS did not significantly differ, mortality was higher among infants with lower mean arterial pressure [ 24 ]. It has been hypothesized that rapid clearance of vasoactive medications and dilutional effects could worsen hemodynamic status [ 22 ]. Therefore, inotropes and vasopressors should be titrated and adjusted based on the clinical response [25In addition, transitioning to intermittent hemodialysis with inotropes dependence should be avoided due to worse outcomes [ 26 ]. We also noted that anticoagulant use during CKRT was associated with better outcomes, which could be due to improving CKRT performance by reducing the risk of circuit thrombosis [ 16 , 27 – 29 ]. However, CKRT is sometimes performed without anticoagulation in cases with disordered coagulation, such as disseminated intravascular coagulation (DIC), which causes thrombosis and hemorrhages that worsen organ dysfunction, such as AKI, in the context of septic shock [ 29 – 31 ]. We hypothesize that the use of unfractionated heparin or citrate may be associated with favorable outcomes in pediatric patients with DIC requiring CKRT. Firstly, since sepsis is simultaneously a risk factor for bleeding and hypercoagulable status, the CKRT circuit might benefit from anticoagulants [ 32 ]. Secondly, a meta-analysis conducted on adults showed that anticoagulants significantly reduced mortality in sepsis-induced DIC cases [ 30 ]. This notion is supported by a randomized controlled trial that showed that using heparin before DIC develops is associated with better outcomes and a lower risk of bleeding [ 34 ]. The early initiation of CKRT in adults was associated with better survival (OR = 1.02, 95% CI = 1.01–1.03, p = 0.003) [ 5 ]. Furthermore, a prospective, multicenter observational study on adult patients found higher morbidity and hospitalization with late initiation of CKRT (> 5 days) [ 16 ]. However, these findings were not comparable in pediatric populations. In childhood, the etiology of AKI is usually multifactorial, and numerous factors affect outcomes, such as the degree of fluid overload and the presence of other congenital anomalies [ 2 , 35 – 36 ]. For example, in the ppCRRT registry, the median time to CKRT initiation was 2 (0.0–27.1) days in the survived group and 3.4 (0.0–64.0) days in the deceased group [ 7 ]. Our study had limitations despite using rigorous statistical tools, such as LASSO regression and bootstrap validation. Firstly, its single-center, retrospective design may limit its generalizability, and other confounding predictors cannot be entirely excluded. Secondly, it did not consider variations in clinical practice, including CKRT dose and anticoagulation procedures, which warrant further investigation in multicenter prospective studies. Thirdly, its power to detect predictors of mortality may have been reduced by variation in CKRT timing; therefore, future studies should consider standardized CKRT approach to strengthen their results. Nonetheless, investigating biomarkers to detect AKI early and monitor CKRT in real time could significantly improve treatment accuracy. Conclusion The use of inotropic support and prescribing CKRT without anticoagulation were associated with significantly increased mortality among critically ill pediatric patients receiving CKRT, which could represent hemodynamic instability and abnormal coagulation, respectively. We recommend incorporating these predictors in risk stratification to improve clinical outcomes. Declarations Disclosures: All authors have nothing to disclose. Conflict of interest: None Author contribution: Conceptualization: Abdulsalam S Alrashdi, Jasir N Alshammari, Khawla A Rahim, Saeed M AlZabali Supervision: Khawla A Rahim, Saeed M AlZabali, Ibrahim A Sandokji Methodology and Formal Analysis: Ibrahim A Sandokji, Sulaiman K Abdullah Writing – original draft: Abdulsalam S Alrashdi, Jasir N Alshammari, Sulaiman K Abdullah, Sulaiman I ALqannas Writing – review & editing: Khawla A Rahim, Saeed M AlZabali, Ibrahim A Sandokji References de Galasso L, Emma F, Picca S, Di Nardo M, Rossetti E, Guzzo I (2016) Continuous renal replacement therapy in children: Fluid overload does not always predict mortality. Pediatr Nephrol 31:651-659. https://doi.org/10.1007/s00467-015-3248-6 Rustagi RS, Arora K, Das RR, Pooni PA, Singh D (2017) Incidence, risk factors and outcome of acute kidney injury in critically ill children – A developing country perspective. 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Pediatr Nephrol 38:3145–3152. https://doi.org/10.1007/s00467-023-05944-8 Verma S, Palevsky PM (2021). Prescribing continuous kidney replacement therapy in acute kidney injury: A narrative review. Kidney Med 3:827–836. https://doi.org/10.1016/j.xkme.2021.05.006 Chan RJ, Helmeczi W, Canney M, Clark EG (2023) Management of intermittent hemodialysis in the critically ill patient. Clin J Am Soc Nephrol 18:245–255. https://doi.org/10.2215/CJN.04000422 Raina R, Chakraborty R, Davenport A, et al (2022) Anticoagulation in patients with acute kidney injury undergoing kidney replacement therapy. Pediatr Nephrol 37:2303–2330. https://doi.org/10.1007/s00467-021-05020-z Zhu D, He J, Xiao Z, Zhou X, Zhang X (2024) Citrate and low-dose heparin combined anticoagulation in pediatric continuous renal replacement therapy. Sci Rep 14:13504. https://doi.org/10.1038/s41598-024-64433-6 Brophy PD, Somers MJ, Baum MA, et al (2005) Multi-centre evaluation of anticoagulation in patients receiving continuous renal replacement therapy (CRRT). Nephrol Dial Transplant 20:1416–1421. https://doi.org/10.1093/ndt/gfh817 Helms J, Merdji H, Loewert S, et al (2023) Disseminated intravascular coagulation is strongly associated with severe acute kidney injury in patients with septic shock. Ann Intensive Care 13:119. https://doi.org/10.1186/s13613-023-01216-8 Jhang WK, Ha E, Park SJ (2018) Evaluation of disseminated intravascular coagulation scores in critically ill pediatric patients with septic shock. J Crit Care 47:104–108. https://doi.org/10.1016/j.jcrc.2018.06.017 Agarwal B, Shaw S, Shankar Hari M, Burroughs AK, Davenport A (2009) Continuous renal replacement therapy (CRRT) in patients with liver disease: is circuit life different? J Hepatol 51:504–509. https://doi.org/10.1016/j.jhep.2009.05.028 Umemura Y, Yamakawa K, Ogura H, Yuhara H, Fujimi S (2016) Efficacy and safety of anticoagulant therapy in three specific populations with sepsis: A meta-analysis of randomized controlled trials. J Thromb Haemost 14:518–530. https://doi.org/10.1111/jth.13230 El-Nawawy AA, Elshinawy MI, Khater DM, et al (2021) Outcome of early hemostatic intervention in children with sepsis and nonovert disseminated intravascular coagulation admitted to PICU: A randomized controlled trial. Pediatr Crit Care Med. 22:e168–e177. https://doi.org/10.1097/PCC.0000000000002578 Hayes LW, Oster RA, Tofil NM, Tolwani AJ (2009) Outcomes of critically ill children requiring continuous renal replacement therapy. J Crit Care 24:394–400. https://doi.org/10.1016/j.jcrc.2008.12.017 Modem V, Thompson M, Gollhofer D, Dhar AV, Quigley R (2014) Timing of continuous renal replacement therapy and mortality in critically ill children. Crit Care Med 42:943–953. https://doi.org/10.1097/CCM.0000000000000039 Cite Share Download PDF Status: Published Journal Publication published 14 May, 2025 Read the published version in Pediatric Nephrology → Version 1 posted Editorial decision: Major Revisions Needed 24 Jan, 2025 Reviewers agreed at journal 30 Dec, 2024 Reviewers invited by journal 30 Dec, 2024 Editor assigned by journal 30 Dec, 2024 First submitted to journal 28 Dec, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5726801","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":395955459,"identity":"5182aaf3-6acf-41ef-9e79-f7b5e5f69fab","order_by":0,"name":"Abdulsalam S Alrashdi","email":"","orcid":"","institution":"Maternity and Children Hospital","correspondingAuthor":false,"prefix":"","firstName":"Abdulsalam","middleName":"S","lastName":"Alrashdi","suffix":""},{"id":395955460,"identity":"9f3214c7-d775-4fbd-899c-5a36df918dce","order_by":1,"name":"Jaser N Alshammari","email":"","orcid":"","institution":"Maternity and Children Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jaser","middleName":"N","lastName":"Alshammari","suffix":""},{"id":395955461,"identity":"6050d5a3-4b39-4263-beb5-e0b5dd8e2c98","order_by":2,"name":"Sulaiman K Abdullah","email":"","orcid":"","institution":"Taibah University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Sulaiman","middleName":"K","lastName":"Abdullah","suffix":""},{"id":395955462,"identity":"57ff8c05-f38b-487e-84ad-ccff00de3b7a","order_by":3,"name":"Sulaiman Alqannas","email":"","orcid":"","institution":"Maternity and Children's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sulaiman","middleName":"","lastName":"Alqannas","suffix":""},{"id":395955463,"identity":"35c8ddd3-0fe4-46b8-8d2b-c6786516b680","order_by":4,"name":"Hassan Faqeehi","email":"","orcid":"","institution":"King Fahad Medical City","correspondingAuthor":false,"prefix":"","firstName":"Hassan","middleName":"","lastName":"Faqeehi","suffix":""},{"id":395955464,"identity":"efd7e7bf-f899-471a-b406-9c15047a2952","order_by":5,"name":"Sawsan Albatati","email":"","orcid":"","institution":"King Fahad Medical City","correspondingAuthor":false,"prefix":"","firstName":"Sawsan","middleName":"","lastName":"Albatati","suffix":""},{"id":395955465,"identity":"cd7ccd03-d93b-446f-80fb-c4178ad276cd","order_by":6,"name":"Khawla A Rahim","email":"","orcid":"","institution":"King Fahad Medical City","correspondingAuthor":false,"prefix":"","firstName":"Khawla","middleName":"A","lastName":"Rahim","suffix":""},{"id":395955466,"identity":"87b5007d-a752-42d9-8729-4dc3443c81fe","order_by":7,"name":"Ibrahim A Sandokji","email":"","orcid":"","institution":"Taibah University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ibrahim","middleName":"A","lastName":"Sandokji","suffix":""},{"id":395955467,"identity":"ce4c3592-9fd6-4836-a43f-d6c3bdc2d068","order_by":8,"name":"Abdulkarim S Alanazi","email":"","orcid":"","institution":"King Fahad Medical City","correspondingAuthor":false,"prefix":"","firstName":"Abdulkarim","middleName":"S","lastName":"Alanazi","suffix":""},{"id":395955468,"identity":"9c0f7d6a-00fb-4de7-aaac-03c50793d95b","order_by":9,"name":"Saeed Mohammed Al Zabali","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYDACdgYGZoYCCQZ+ECehgBgtzCBkIMEg2QDSYkC8FgYGgwMgHjFa+JvZH34uMLCwN76RnfjhgQGDPL/YAfxaJA4zJEvPMJBI3HYjd7ME0GGGM2cnELDmMMMBaR4DiQSzG7kbQFoSDG4T0CJ/mLH5N1CLvfGM3M0/iNJicJiZDWQL4waJ3G3E2WJ4mI3NGuSXGWfebrNIMJAg7Be54+2PbxdU1Nnzt+duvvmjwkaeX5qAFgQQAKuUIFY5CPAfIEX1KBgFo2AUjCQAAMIVPHHyjUf/AAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0001-8815-4765","institution":"King Fahad Medical City","correspondingAuthor":true,"prefix":"","firstName":"Saeed","middleName":"Mohammed Al","lastName":"Zabali","suffix":""}],"badges":[],"createdAt":"2024-12-28 15:16:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5726801/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5726801/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00467-025-06794-2","type":"published","date":"2025-05-14T15:57:02+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":72755765,"identity":"2d1cdd13-a61a-43c6-8567-0a2fd1d5c474","added_by":"auto","created_at":"2025-01-01 16:54:43","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":46579,"visible":true,"origin":"","legend":"\u003cp\u003ePediatric CKRT outcomes.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5726801/v1/d25821bf3b1b2b2a3e1e66f5.jpg"},{"id":83067689,"identity":"c4dac7d0-08cf-4082-a3d0-4b7a7af0877b","added_by":"auto","created_at":"2025-05-19 16:03:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1171850,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5726801/v1/6d412d58-81e8-49f2-adc0-723cf38b5368.pdf"}],"financialInterests":"","formattedTitle":"Outcomes of continuous kidney replacement therapy in pediatric patients: The impact of timing and predictors of mortality","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAcute kidney injury (AKI) is recognized as a predictor of worse outcomes in critically ill pediatric patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. AKI is often multifactorial, with sepsis, respiratory failure, congenital heart disease, and nephrotoxic medication use involved in its pathogenesis [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. AKI increases mortality sixfold, even after adjustment for baseline characteristics [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Continuous kidney replacement therapy (CKRT) could improve AKI outcomes by correcting metabolic disturbances and fluid removal while maintaining hemodynamic stability [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile the predictors of CKRT outcomes remain controversial, several studies identified anticoagulant use, CKRT dosing, and the timing of CKRT initiation as significant determinants [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Several studies have hypothesized that early initiation of CKRT is associated with preferable outcomes [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, two systematic reviews assessing the timing of CKRT initiation on outcomes in adults found that early initiation did not significantly reduce mortality despite decreased metabolic acidosis development, in addition to three adult randomized controlled trials demonstrating insignificant effects [\u003cspan additionalcitationids=\"CR10 CR11 CR12\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A retrospective pediatric cohort study showed better outcomes with early CKRT initiation. However, the Prospective Pediatric Continuous Renal Replacement Therapy (ppCRRT) registry reported higher mortality in pediatric patients weighing\u0026thinsp;\u0026lt;\u0026thinsp;10 kg, resulting in a debatable statement in the timing of CKRT initiation [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to assess CKRT outcomes in a heterogeneous group of critically ill pediatric patients, focusing on predictors of mortality and the impact of the timing of CKRT initiation.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population, period, and design\u003c/h2\u003e \u003cp\u003e This retrospective cohort study reviewed the medical records of all pediatric patients admitted to the intensive care unit (ICU) at King Fahad Medical City\u0026mdash;a tertiary care center in Riyadh, Saudi Arabia\u0026mdash;who received inpatient CKRT between 2007 and 2021. AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes definition [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Patients on chronic dialysis or with insufficient data were excluded. The treating physicians determined CKRT initiation according to local policy.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eExposures and outcomes\u003c/h3\u003e\n\u003cp\u003ePatients\u0026rsquo; demographic characteristics were collected from their medical records, including age, sex, nationality, and anthropometric measurements. Their clinical data were also collected, including baseline clinical and laboratory characteristics at ICU admission and CKRT initiation. Pediatric Risk of Mortality (PRISM) III score was also documented. The examined CKRT characteristics were therapy duration (days), number of sessions, vascular access, catheter size, CKRT mode (continuous veno-venous hemodialysis [CVVHD], continuous veno-venous hemofiltration [CVVH], or continuous hemodiafiltration [CVVHDF]), CKRT dose (mL/kg/session), blood flow rate (mL/min), and anticoagulation use. The primary outcome was in-hospital mortality. Fluid overload was defined as a\u0026thinsp;\u0026ge;\u0026thinsp;10% increase in total body water, determined by fluid balance and body weight at ICU admission, ideal body weight, or clinical evidence of water retention. Fluid balance was determined by subtracting the present weight from the admission weight and dividing the result by the admission weight.\u003c/p\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e This study received ethical approval from the King Fahad Medical City institutional review board (committee registration H-01-R-012/IRB00010470; Study approval FWA00018774).\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe data were collected using Microsoft Excel 365 (Seattle, WA, USA). The demographic and clinical data were descriptively summarized as medians (interquartile ranges [IQRs]) for continuous variables and numbers (percentages) for categorical variables. Variables were compared between patients who survived and died using the Mann\u0026ndash;Whitney U test for continuous variables and the chi-square or Fisher\u0026rsquo;s exact test for categorical variables. Continuous variables with clinically known categories, such as albumin level, are presented as both continuous and categorical variables. A \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003cp\u003eThe best predictors of mortality were identified using least absolute shrinkage and selection operator (LASSO) regression, which included all variables that were significant in the descriptive analysis screening. The LASSO regression was tenfold cross-validated to select the optimal regularization parameter (λ) and prevent overfitting; λ was selected within one standard error of the minimum mean squared prediction error. Then, the selected variables underwent multivariable logistic regression. The odds ratio (OR) and its 95% confidence interval (CI) and \u003cem\u003ep\u003c/em\u003e-value are reported for each variable in this model. Lastly, given the relatively small sample size, the stability and generalizability of this logistic regression model were assessed using bootstrap validation with 1000 replicates. The statistical analyses were performed using the STATA statistical software (version 15.1; StataCorp, College Station, TX, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis study enrolled 113 pediatric patients who met the eligibility criteria (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), of whom 83 (73.5%) survived and 30 (26.6%) died. Among participants, over half were male (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;45, 54.2%), and the median age was 24 (9\u0026ndash;132) months, with nearly two-thirds (65.5%) aged over one year. In addition, their median height was 86 (62\u0026ndash;134) cm. Notably, body weights were significantly higher in the survived group (median\u0026thinsp;=\u0026thinsp;14.0 [8.5\u0026ndash;30.5] kg) than in the deceased group (median\u0026thinsp;=\u0026thinsp;7.7 [3.7\u0026ndash;27.0] kg; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of the pediatric patients who received CKRT.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;113)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eSurvived\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;83, 73.5%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eDeceased\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;30, 26.6%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eDemographic characteristic\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSex, male (n [%])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e45 (54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e16 (53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAge, months (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (9\u0026ndash;132)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e24 (12\u0026ndash;132)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e24 (1.6\u0026ndash;132)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003eNeonates (\u0026lt;\u0026thinsp;1 mo)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eInfants (1\u0026ndash;12 mo)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eChildren (\u0026gt;\u0026thinsp;12 mo)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e7 (23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e19 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e6 (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (65.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e57 (68.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e17 (56.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eWeight, kg (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (6.6\u0026ndash;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e14 (8.5\u0026ndash;30.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e7.7 (3.7\u0026ndash;27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHeight, cm (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86 (62\u0026ndash;134)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e93 (70\u0026ndash;135)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e78 (52\u0026ndash;134)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eBaseline clinical characteristics at ICU admission\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePRISM III Score, (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e8 (4\u0026ndash;14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e7 (3\u0026ndash;13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10 (8\u0026ndash;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSepsis Admission, (n [%])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e43 (38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e19 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24 (80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eIntubation, (n [%])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e71 (62.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e43 (51.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28 (93.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eVentilation duration, days (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e4 (0\u0026ndash;14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1 (0\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17.5 (11\u0026ndash;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaboratories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSerum creatinine, \u0026micro;mol/L (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e152 (54\u0026ndash;467)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e260 (87\u0026ndash;623)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e46 (34\u0026ndash;119)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eBUN, mmol/L (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e14.7 (5\u0026ndash;29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e21 (9.9\u0026ndash;35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5 (3.7\u0026ndash;8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePotassium, mmol/L (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e4 (3.5\u0026ndash;4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4 (3.5\u0026ndash;4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.3 (3.6\u0026ndash;4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSodium, mmol/L (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e137 (133\u0026ndash;141)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e136 (133\u0026ndash;141)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e138.5 (134\u0026ndash;141)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAlbumin, g/dL (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e26.1 (22\u0026ndash;31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e27 (22.5\u0026ndash;32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25.7 (19.7\u0026ndash;29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin categories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;30 g/dL, (n [%])\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ge;\u0026thinsp;30 g/dL, (n [%])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e76 (67.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e51 (61.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e37 (32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e32 (38.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5 (16.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAt ICU admission, PRISM III scores were significantly higher in the deceased group (median\u0026thinsp;=\u0026thinsp;10 [\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14 CR15\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]) than in the survived group (median\u0026thinsp;=\u0026thinsp;7 [\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). In addition, admission due to sepsis was significantly more common in the deceased group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;24, 80%) than in the survived group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;19, 22.9%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), consistent with the significantly higher intubation rate in the deceased group (93.3%) than in the survived group (51.8%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and the significantly longer ventilation periods in the deceased group (median\u0026thinsp;=\u0026thinsp;17.5 [\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31 CR32 CR33\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] days) than in the survived group (median\u0026thinsp;=\u0026thinsp;1 [0\u0026ndash;7] day; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003eThe laboratory results at ICU admission showed significant differences between the survived and decreased groups for serum creatinine (median\u0026thinsp;=\u0026thinsp;260 [87\u0026ndash;623] vs. 46 [34\u0026ndash;119] \u0026micro;mol/L) and blood urea nitrogen (BUN; median\u0026thinsp;=\u0026thinsp;21 [9.9\u0026ndash;35.] vs. 5 [3.7\u0026ndash;8.4] mmol/L; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Moreover, hypoalbuminemia was significantly more common in the deceased group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;25, 83.3%) than in the survived group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;51, 61.5%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04).\u003c/p\u003e \u003cp\u003eMultifactorial AKI was more common in the deceased group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;25, 83.3%) than in the survived group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;26, 31.3%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The primary indication for CKRT was fluid overload, which was more common in the deceased group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8, 26.7%) than in the survived group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5, 6%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01). The ICU stay length before CKRT initiation was higher in the deceased group (median\u0026thinsp;=\u0026thinsp;7 [\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] days) than in the survived group (median\u0026thinsp;=\u0026thinsp;1 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] days; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). More patients required inotropic support in the decreased group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;28, 93.3%) than in the survived group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15, 18.1%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics at CKRT initiation and CKRT prescription information.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;113)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSurvived\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;83, 73.5%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eDeceased\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;30, 26.6%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eBaseline clinical characteristics at CKRT initiation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCause of AKI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003eMultifactorial, (n [%])\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eSeptic shock, (n [%])\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eKidney disease, (n [%])\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eNo acute kidney disease, (n [%])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (45.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e26 (31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e25 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (38.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e41 (49.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3 (10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e12 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2 (6.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndication for CKRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003eFluid overload \u0026amp; electrolyte imbalance, (n [%])\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eFluid overload only, (n [%])\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eElectrolyte imbalance only, (n [%])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e53 (63.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e17 (56.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e8 (26.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e25 (30.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e5 (16.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDays in ICU prior to CKRT, (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (1\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e7 (3\u0026ndash;14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDuration prior to CKRT\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eLess than 48 hrs., (n [%])\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eMore than 48 hrs., (n [%])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (67.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e69 (83.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e7 (23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e14 (16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e23 (76.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFluid overload, (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10% (5\u0026ndash;12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e10% (0\u0026ndash;14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e10% (6\u0026ndash;10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePRISM III score, (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (5\u0026ndash;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e8 (4\u0026ndash;14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e19 (14\u0026ndash;25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eInotropic support, (n [%])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e15 (18.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e28 (93.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of inotropic agents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003eNone, (n [%])\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e1 agent, (n [%])\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ge;\u0026thinsp;2 agents, (n [%])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e68 (81.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (16.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e10 (12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e9 (30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e19 (63.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDiuretic use, (n [%])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94 (83.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e68 (81.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e26 (86.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eUrine output, ml/kg/hr (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.3\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.9 (0.2\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.2 (0.6\u0026ndash;1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaboratories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSerum creatinine, \u0026micro;mol/L (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e192 (84\u0026ndash;467)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e260 (116\u0026ndash;623)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e84 (61\u0026ndash;192)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eBUN, mmol/L (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.3 (9\u0026ndash;30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e21 (10.5\u0026ndash;38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e10 (4.3\u0026ndash;14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePotassium, mmol/L (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (3.6\u0026ndash;4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3.9 (3.5\u0026ndash;4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4.3 (3.9\u0026ndash;4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSodium, mmol/L (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137 (134\u0026ndash;142)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e136 (133\u0026ndash;142)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e138.5 (136\u0026ndash;144)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAlbumin, g/dL (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (22.5\u0026ndash;31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e26 (22.5\u0026ndash;31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e25.2 (21\u0026ndash;28.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCKRT prescription characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;113)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSurvived\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;83, 73.5%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eDeceased\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;30, 26.6%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eCKRT prescription\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCKRT duration, days (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (3\u0026ndash;11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (3\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e12 (2\u0026ndash;22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKRT sessions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eLess than 10 sessions, (n [%])\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eMore than 10 sessions, (n [%])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (72.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e68 (81.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e14 (46.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (27.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e15 (18.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e16 (53.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVascular access\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003eFemoral, (n [%])\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eInternal jugular, (n [%])\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eSubclavian, (n [%])\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eExternal jugular, (n [%])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (41.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e39 (46.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e8 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (54.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e40 (48.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e22 (73.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCKRT catheter size, (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3 (2\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2 (2\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKRT mode\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003eCVVHD, (n [%])\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eCVVH, (n [%])\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eCVVHDF, (n [%])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (25.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e28 (33.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (69.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e50 (60.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e29 (96.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCKRT dose, mL/kg/session (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (31\u0026ndash;64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e41.2 (30\u0026ndash;54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e56.5 (38.4\u0026ndash;77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKRT dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e\u0026le;\u0026thinsp;50 mL/kg/h, (n [%])\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026gt;\u0026thinsp;50 mL/kg/h, (n [%])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (64.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e60 (72.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e13 (43.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (35.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e23 (27.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e17 (56.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eBlood flow rate (average/pat), mL/min (median [IQR])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3 (2\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2 (1\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnticoagulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eHeparin, (n [%])\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eNo anticoagulation, (n [%])\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (61.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e63 (75.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e6 (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (38.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e20 (24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e24 (80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCKRT duration did not differ significantly between the survived group (median\u0026thinsp;=\u0026thinsp;6 [\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8 CR9\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] days) and the deceased group (median\u0026thinsp;=\u0026thinsp;12 [\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31 CR32 CR33\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] days; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.14). In contrast, significantly more patients underwent more than 10 CKRT sessions in the deceased group (53.3%) than in the survived group (18.3%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The CVVH mode was used more often in the deceased group (96.7%) than in the survived group (60.2%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) while CCVHD was more frequent in the survived group (33.7%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and less frequent of CVVHD use in overall (4.4%). The CKRT dose and anticoagulation use differed significantly between groups, with 72.3% of the survived group and 43.3% of the deceased group receiving\u0026thinsp;\u0026lt;\u0026thinsp;50 mL/kg/h (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and 75.9% of the survived group and 20% of the deceased group receiving heparin (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003eUsing cross-validated LASSO regression of all variables differing significantly between the deceased and survived groups, the following variables were identified as predicting mortality: sepsis at ICU admission, PRISM III score at CKRT initiation, inotropic support at CKRT initiation, not using anticoagulation during CKRT, and CKRT initiation of \u0026gt;\u0026thinsp;48 hours after ICU admission. These variables were then combined in a multivariable regression model, which showed that patients receiving inotropic support at CKRT initiation had a significantly higher risk of mortality (adjusted OR [aOR]\u0026thinsp;=\u0026thinsp;15.068, 95% CI\u0026thinsp;=\u0026thinsp;2.487\u0026ndash;91.306; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). This association remained significant after bootstrap validation (OR\u0026thinsp;=\u0026thinsp;15.068, 95% CI\u0026thinsp;=\u0026thinsp;1.059\u0026ndash;214.414). Additionally, no anticoagulant use during CKRT was associated with an increased risk of mortality (aOR\u0026thinsp;=\u0026thinsp;4.699, 95% CI\u0026thinsp;=\u0026thinsp;1.156\u0026ndash;19.104); however, this association was not significant after bootstrap validation (OR\u0026thinsp;=\u0026thinsp;4.699, 95% CI\u0026thinsp;=\u0026thinsp;0.591\u0026ndash;37.379). No significant associations were found between mortality and sepsis at ICU admission, PRISM III score at CKRT initiation, or CKRT initiation\u0026thinsp;\u0026gt;\u0026thinsp;48 hours after ICU admission (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe process of identifying the most predictive features, including cross-validated LASSO regression with tenfold cross-validation, followed by multivariable logistic regression of the identified features and bootstrap validation with 1000 replications.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFeatures selected using Cross-validated LASSO regression*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eMultivariable logistic regression\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eBootstrap validation\u003c/p\u003e \u003cp\u003e(1000 replications)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eaOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eaOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSepsis on admission to ICU\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.761\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.494\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.713\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.590\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePRISM III Score at CKRT initiation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.969\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInotropic support at CKRT initiation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e15.068\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2.487\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e91.306\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e15.068\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e1.059\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e214.414\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.045\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnticoagulation in CKRT (none)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4.699\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.156\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e19.104\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.031\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.699\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.591\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e37.379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCKRT initiation\u0026thinsp;\u0026gt;\u0026thinsp;48 hours of ICU admission\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.726\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e33.479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.367\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003e*Optimal λ for LASSO (22.37) was selected within one standard error of the minimum mean squared prediction error.\u003c/p\u003e \u003cp\u003eLASSO, least absolute shrinkage and selection operator; aOR, adjusted odds ratio.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis cohort study conducted at a tertiary care hospital observed that critically ill pediatric patients undergoing CKRT had a mortality rate of 26.6%. The identified independent predictors of mortality included inotropic support at CKRT initiation and CKRT without anticoagulation use, which could represent hemodynamic instability and disordered coagulation, respectively. The LASSO regression model identified later CKRT initiation (\u0026gt;\u0026thinsp;48 hours), sepsis at ICU admission, and higher PRISM III scores at CKRT initiation as predictors of mortality; however, they were not independently associated with mortality in the multivariable model.\u003c/p\u003e \u003cp\u003eThe need for inotropic support indicates a significant condition that influences CKRT outcomes [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. It could reflect a hemodynamic compromise with low cardiac output and organ failures [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Lavefer et al. suggested that CKRT stabilizes the hemodynamic status through various mechanisms, including removing excess fluids and reducing body temperature, which may help in the inotropic support context [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This notion is supported by their observation of an initial drop in blood pressure followed by a reversal within the next 15 minutes. In contrast, a single-center retrospective cohort study found that only heart rate decreased and normalized while hypotension events remained escalating alongside the vasoactive inotropic score (VIS) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. While the VIS is an independent predictor of mortality in pediatric patients with sepsis [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], it was not significantly associated with survival in infants undergoing CKRT [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Notably, while the VIS did not significantly differ, mortality was higher among infants with lower mean arterial pressure [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. It has been hypothesized that rapid clearance of vasoactive medications and dilutional effects could worsen hemodynamic status [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Therefore, inotropes and vasopressors should be titrated and adjusted based on the clinical response [25In addition, transitioning to intermittent hemodialysis with inotropes dependence should be avoided due to worse outcomes [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe also noted that anticoagulant use during CKRT was associated with better outcomes, which could be due to improving CKRT performance by reducing the risk of circuit thrombosis [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, CKRT is sometimes performed without anticoagulation in cases with disordered coagulation, such as disseminated intravascular coagulation (DIC), which causes thrombosis and hemorrhages that worsen organ dysfunction, such as AKI, in the context of septic shock [\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. We hypothesize that the use of unfractionated heparin or citrate may be associated with favorable outcomes in pediatric patients with DIC requiring CKRT. Firstly, since sepsis is simultaneously a risk factor for bleeding and hypercoagulable status, the CKRT circuit might benefit from anticoagulants [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Secondly, a meta-analysis conducted on adults showed that anticoagulants significantly reduced mortality in sepsis-induced DIC cases [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. This notion is supported by a randomized controlled trial that showed that using heparin before DIC develops is associated with better outcomes and a lower risk of bleeding [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe early initiation of CKRT in adults was associated with better survival (OR\u0026thinsp;=\u0026thinsp;1.02, 95% CI\u0026thinsp;=\u0026thinsp;1.01\u0026ndash;1.03, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Furthermore, a prospective, multicenter observational study on adult patients found higher morbidity and hospitalization with late initiation of CKRT (\u0026gt;\u0026thinsp;5 days) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, these findings were not comparable in pediatric populations. In childhood, the etiology of AKI is usually multifactorial, and numerous factors affect outcomes, such as the degree of fluid overload and the presence of other congenital anomalies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. For example, in the ppCRRT registry, the median time to CKRT initiation was 2 (0.0\u0026ndash;27.1) days in the survived group and 3.4 (0.0\u0026ndash;64.0) days in the deceased group [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study had limitations despite using rigorous statistical tools, such as LASSO regression and bootstrap validation. Firstly, its single-center, retrospective design may limit its generalizability, and other confounding predictors cannot be entirely excluded. Secondly, it did not consider variations in clinical practice, including CKRT dose and anticoagulation procedures, which warrant further investigation in multicenter prospective studies. Thirdly, its power to detect predictors of mortality may have been reduced by variation in CKRT timing; therefore, future studies should consider standardized CKRT approach to strengthen their results. Nonetheless, investigating biomarkers to detect AKI early and monitor CKRT in real time could significantly improve treatment accuracy.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe use of inotropic support and prescribing CKRT without anticoagulation were associated with significantly increased mortality among critically ill pediatric patients receiving CKRT, which could represent hemodynamic instability and abnormal coagulation, respectively. We recommend incorporating these predictors in risk stratification to improve clinical outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclosures:\u003c/strong\u003e All authors have nothing to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConceptualization:\u003c/strong\u003e Abdulsalam S Alrashdi, Jasir N Alshammari, Khawla A Rahim, Saeed M AlZabali\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupervision:\u003c/strong\u003e Khawla A Rahim, Saeed M AlZabali, Ibrahim A Sandokji\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology and Formal Analysis:\u003c/strong\u003e Ibrahim A Sandokji, Sulaiman K Abdullah\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting – original draft:\u003c/strong\u003e Abdulsalam S Alrashdi, Jasir N Alshammari, Sulaiman K Abdullah, Sulaiman I ALqannas\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting – review \u0026amp; editing:\u003c/strong\u003e Khawla A Rahim, Saeed M AlZabali, Ibrahim A Sandokji\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ede Galasso L, Emma F, Picca S, Di Nardo M, Rossetti E, Guzzo I (2016) Continuous renal replacement therapy in children: Fluid overload does not always predict mortality. Pediatr Nephrol\u003cem\u003e \u003c/em\u003e31:651-659. https://doi.org/10.1007/s00467-015-3248-6\u003c/li\u003e\n\u003cli\u003eRustagi RS, Arora K, Das RR, Pooni PA, Singh D (2017) Incidence, risk factors and outcome of acute kidney injury in critically ill children \u0026ndash; A developing country perspective. Paediatr Int Child Health 37:35\u0026ndash;41. https://doi.org/10.1080/20469047.2015.1120409\u003c/li\u003e\n\u003cli\u003eSutherland SM, Alexander SR (2012) Continuous renal replacement therapy in children. Pediatr Nephrol 27:2007\u0026ndash;2016. https://doi.org/10.1007/s00467-011-2080-x\u003c/li\u003e\n\u003cli\u003eKari JA, Alhasan KA, Shalaby MA, et al (2018) Outcome of pediatric acute kidney injury: A multicenter prospective cohort study. Pediatr Nephrol 33:335\u0026ndash;340. https://doi.org/10.1007/s00467-017-3786-1\u003c/li\u003e\n\u003cli\u003eYoon BR, Leem AY, Park MS, Kim YS, Chung KS (2019) Optimal timing of initiating continuous renal replacement therapy in septic shock patients with acute kidney injury. Sci Rep 9:11981. https://doi.org/10.1038/s41598-019-48418-4\u003c/li\u003e\n\u003cli\u003eDeja A, Guzzo I, Cappoli A, et al (2023) Factors influencing circuit lifetime in paediatric continuous kidney replacement therapies \u0026ndash; Results from the EurAKId registry. Pediatr Nephrol 39:3353\u0026ndash;3362. https://doi.org/10.1007/s00467-024-06459-6\u003c/li\u003e\n\u003cli\u003eModem V, Thompson M, Gollhofer D, Dhar AV, Quigley R (2014) Timing of continuous renal replacement therapy and mortality in critically ill children. Crit Care Med 42:943\u0026ndash;953. https://doi.org/10.1097/CCM.0000000000000039\u003c/li\u003e\n\u003cli\u003eBanigan MA, Keim G, Traynor D, Yehya N, Lindell RB, Fitzgerald JC (2024) Association of continuous kidney replacement therapy timing and mortality in critically ill children. Pediatr Nephrol 39:2217\u0026ndash;2226. https://doi.org/10.1007/s00467-024-06320-w\u003c/li\u003e\n\u003cli\u003eXiao L, Jia L, Li R, Zhang Y, Ji H, Faramand A (2019) Early versus late initiation of renal replacement therapy for acute kidney injury in critically ill patients: A systematic review and meta-analysis. PLoS One 14:e0223493. https://doi.org/10.1371/journal.pone.0223493\u003c/li\u003e\n\u003cli\u003eWierstra BT, Kadri S, Alomar S, Burbano X, Barrisford GW, Kao RL (2016)| The impact of \u0026ldquo;early\u0026rdquo; versus \u0026ldquo;late\u0026rdquo; initiation of renal replacement therapy in critical care patients with acute kidney injury: A systematic review and evidence synthesis. Crit Care 20:122. https://doi.org/10.1186/s13054-016-1291-8\u003c/li\u003e\n\u003cli\u003eZarbock A, Kellum JA, Schmidt C, et al. Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients With Acute Kidney Injury: The ELAIN Randomized Clinical Trial. \u003cem\u003eJAMA\u003c/em\u003e. 2016;315(20):2190-2199. doi:10.1001/jama.2016.5828\u003c/li\u003e\n\u003cli\u003eGaudry S, Hajage D, Schortgen F, et al. Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit. \u003cem\u003eN Engl J Med\u003c/em\u003e. 2016;375(2):122-133. doi:10.1056/NEJMoa1603017\u003c/li\u003e\n\u003cli\u003eBarbar SD, Clere-Jehl R, Bourredjem A, et al. Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis. \u003cem\u003eN Engl J Med\u003c/em\u003e. 2018;379(15):1431-1442. doi:10.1056/NEJMoa1803213\u003c/li\u003e\n\u003cli\u003eAskenazi DJ, Goldstein SL, Koralkar R, et al (2013) Continuous renal replacement therapy for children \u0026le;10 kg: A report from the prospective pediatric continuous renal replacement therapy registry. J Pediatr 162:587\u0026ndash;592.e3. https://doi.org/10.1016/j.jpeds.2012.08.044\u003c/li\u003e\n\u003cli\u003eKhwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 120:c179\u0026ndash;c184. https://doi.org/10.1159/000339789\u003c/li\u003e\n\u003cli\u003eBagshaw SM, Uchino S, Bellomo R, et al (2009) Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury. J Crit Care 24:129\u0026ndash;140. https://doi.org/10.1016/j.jcrc.2007.12.017\u003c/li\u003e\n\u003cli\u003eSutherland SM, Zappitelli M, Alexander SR, et al (2010) Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis 55:316\u0026ndash;325. https://doi.org/10.1053/j.ajkd.2009.10.048\u003c/li\u003e\n\u003cli\u003eImberti S, Comoretto R, Ceschia G, et al (2024) Impact of the first 24 h of continuous kidney replacement therapy on hemodynamics, ventilation, and analgo-sedation in critically ill children. Pediatr Nephrol 39:879\u0026ndash;887. https://doi.org/10.1007/s00467-023-06155-x\u003c/li\u003e\n\u003cli\u003eMcIntosh AM, Tong S, Deakyne SJ, Davidson JA, Scott HF (2017) Validation of the Vasoactive-Inotropic Score in pediatric sepsis. Pediatr Crit Care Med 18:750\u0026ndash;757. https://doi.org/10.1097/PCC.0000000000001191\u003c/li\u003e\n\u003cli\u003eMeert KL, Banks R, Holubkov R, Pollack MM; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (2020) Morbidity and mortality in critically ill children. II. A qualitative patient-level analysis of pathophysiologies and potential therapeutic solutions. Crit Care Med 48:799\u0026ndash;807. https://doi.org/10.1097/CCM.0000000000004332\u003c/li\u003e\n\u003cli\u003eFern\u0026aacute;ndez Lafever SN, L\u0026oacute;pez J, Gonz\u0026aacute;lez R, et al (2021) Hemodynamic disturbances and oliguria during continuous kidney replacement therapy in critically ill children. Pediatr Nephrol 36:1889\u0026ndash;1899. https://doi.org/10.1007/s00467-020-04804-z\u003c/li\u003e\n\u003cli\u003eThadani S, Fogarty T, Mottes T, et al (2022) Hemodynamic instability during connection to continuous kidney replacement therapy in critically ill pediatric patients. Pediatr Nephrol 37:2167\u0026ndash;2177. https://doi.org/10.1007/s00467-022-05424-5\u003c/li\u003e\n\u003cli\u003eKallekkattu D, Rameshkumar R, Chidambaram M, Krishnamurthy K, Selvan T, Mahadevan S (2022) Threshold of Inotropic Score and Vasoactive-Inotropic Score for predicting mortality in pediatric septic shock. Indian J Pediatr 89:432\u0026ndash;437. https://doi.org/10.1007/s12098-021-03846-x\u003c/li\u003e\n\u003cli\u003eXu J, Fang L, Chen J, et al (2023) Real-life effects, complications, and outcomes in 39 critically ill neonates receiving continuous kidney replacement therapy. Pediatr Nephrol 38:3145\u0026ndash;3152. https://doi.org/10.1007/s00467-023-05944-8\u003c/li\u003e\n\u003cli\u003eVerma S, Palevsky PM (2021). Prescribing continuous kidney replacement therapy in acute kidney injury: A narrative review. Kidney Med 3:827\u0026ndash;836. https://doi.org/10.1016/j.xkme.2021.05.006\u003c/li\u003e\n\u003cli\u003eChan RJ, Helmeczi W, Canney M, Clark EG (2023) Management of intermittent hemodialysis in the critically ill patient. Clin J Am Soc Nephrol 18:245\u0026ndash;255. https://doi.org/10.2215/CJN.04000422\u003c/li\u003e\n\u003cli\u003eRaina R, Chakraborty R, Davenport A, et al (2022) Anticoagulation in patients with acute kidney injury undergoing kidney replacement therapy. Pediatr Nephrol 37:2303\u0026ndash;2330. https://doi.org/10.1007/s00467-021-05020-z\u003c/li\u003e\n\u003cli\u003eZhu D, He J, Xiao Z, Zhou X, Zhang X (2024) Citrate and low-dose heparin combined anticoagulation in pediatric continuous renal replacement therapy. Sci\u003cem\u003e \u003c/em\u003eRep 14:13504. https://doi.org/10.1038/s41598-024-64433-6\u003c/li\u003e\n\u003cli\u003eBrophy PD, Somers MJ, Baum MA, et al (2005) Multi-centre evaluation of anticoagulation in patients receiving continuous renal replacement therapy (CRRT). Nephrol Dial Transplant 20:1416\u0026ndash;1421. https://doi.org/10.1093/ndt/gfh817\u003c/li\u003e\n\u003cli\u003eHelms J, Merdji H, Loewert S, et al (2023) Disseminated intravascular coagulation is strongly associated with severe acute kidney injury in patients with septic shock. Ann Intensive Care 13:119. https://doi.org/10.1186/s13613-023-01216-8\u003c/li\u003e\n\u003cli\u003eJhang WK, Ha E, Park SJ (2018) Evaluation of disseminated intravascular coagulation scores in critically ill pediatric patients with septic shock. J Crit Care 47:104\u0026ndash;108. https://doi.org/10.1016/j.jcrc.2018.06.017\u003c/li\u003e\n\u003cli\u003eAgarwal B, Shaw S, Shankar Hari M, Burroughs AK, Davenport A (2009) Continuous renal replacement therapy (CRRT) in patients with liver disease: is circuit life different? J Hepatol 51:504\u0026ndash;509. https://doi.org/10.1016/j.jhep.2009.05.028\u003c/li\u003e\n\u003cli\u003eUmemura Y, Yamakawa K, Ogura H, Yuhara H, Fujimi S (2016) Efficacy and safety of anticoagulant therapy in three specific populations with sepsis: A meta-analysis of randomized controlled trials. J Thromb Haemost 14:518\u0026ndash;530. https://doi.org/10.1111/jth.13230\u003c/li\u003e\n\u003cli\u003eEl-Nawawy AA, Elshinawy MI, Khater DM, et al (2021) Outcome of early hemostatic intervention in children with sepsis and nonovert disseminated intravascular coagulation admitted to PICU: A randomized controlled trial. Pediatr Crit Care Med. 22:e168\u0026ndash;e177. https://doi.org/10.1097/PCC.0000000000002578\u003c/li\u003e\n\u003cli\u003eHayes LW, Oster RA, Tofil NM, Tolwani AJ (2009) Outcomes of critically ill children requiring continuous renal replacement therapy. J Crit Care 24:394\u0026ndash;400. https://doi.org/10.1016/j.jcrc.2008.12.017\u003c/li\u003e\n\u003cli\u003eModem V, Thompson M, Gollhofer D, Dhar AV, Quigley R (2014) Timing of continuous renal replacement therapy and mortality in critically ill children. Crit Care Med 42:943\u0026ndash;953. https://doi.org/10.1097/CCM.0000000000000039\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pediatric-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pnep","sideBox":"Learn more about [Pediatric Nephrology](http://link.springer.com/journal/467)","snPcode":"467","submissionUrl":"https://www.editorialmanager.com/pnep/default2.aspx","title":"Pediatric Nephrology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Acute kidney injury, Continuous kidney replacement therapy (CKRT), Critically ill children, Pediatrics, Mortality.","lastPublishedDoi":"10.21203/rs.3.rs-5726801/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5726801/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWhile critically ill children receiving continuous kidney replacement therapy (CKRT) are at increased risk of mortality, few studies have examined the predictors of mortality in this population. This study aimed to evaluate CKRT outcomes, focusing on predictors of mortality.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis cohort study included children aged 0\u0026ndash;14 years who received CKRT. It collected baseline, clinical, and laboratory data. Descriptive analyses were performed. Least absolute shrinkage and selection operator (LASSO) regression was used to select the best predictors of mortality. A multivariable logistic regression model was constructed and validated with 1000 bootstraps.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study included 113 children who received CKRT, of whom 83 (73.5%) survived and 30 (26.6%) died. Children admitted to the intensive care unit with a higher Pediatric Risk of Mortality III score, sepsis, longer intubation, or hypoalbuminemia (\u0026lt;\u0026thinsp;30 g/dL) were more likely to die. Multifactorial acute kidney injury was more common in those who died than in those who survived (83.3% vs. 31.3%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). As the exclusive indication for CKRT, fluid overload was more common in those who died than in those who survived (26.7% vs. 6.0%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01). LASSO and multivariable regression models identified hemodynamic instability, as evidenced by inotropic support use, and abnormal coagulation, as evidenced by not using anticoagulation, as independent predictors of morality. Initiating CKRT late (\u0026gt;\u0026thinsp;48 hours) was associated with mortality in the univariate but not the multivariate analysis.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eHemodynamic instability was the best predictor of mortality in critically ill children receiving CKRT.\u003c/p\u003e","manuscriptTitle":"Outcomes of continuous kidney replacement therapy in pediatric patients: The impact of timing and predictors of mortality","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-01 16:54:38","doi":"10.21203/rs.3.rs-5726801/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major Revisions Needed","date":"2025-01-24T11:23:57+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2024-12-30T19:51:37+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-12-30T19:50:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-12-30T11:20:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pediatric Nephrology","date":"2024-12-28T10:15:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pnep","sideBox":"Learn more about [Pediatric Nephrology](http://link.springer.com/journal/467)","snPcode":"467","submissionUrl":"https://www.editorialmanager.com/pnep/default2.aspx","title":"Pediatric Nephrology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"fb066461-5371-4ea0-b885-13645a5530f3","owner":[],"postedDate":"January 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-19T15:58:55+00:00","versionOfRecord":{"articleIdentity":"rs-5726801","link":"https://doi.org/10.1007/s00467-025-06794-2","journal":{"identity":"pediatric-nephrology","isVorOnly":false,"title":"Pediatric Nephrology"},"publishedOn":"2025-05-14 15:57:02","publishedOnDateReadable":"May 14th, 2025"},"versionCreatedAt":"2025-01-01 16:54:38","video":"","vorDoi":"10.1007/s00467-025-06794-2","vorDoiUrl":"https://doi.org/10.1007/s00467-025-06794-2","workflowStages":[]},"version":"v1","identity":"rs-5726801","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5726801","identity":"rs-5726801","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}