Renal prognosis of shiga-toxin associated hemolytic uremic syndrome according to dialysis therapy

Renal prognosis of shiga-toxin associated hemolytic uremic syndrome according to dialysis therapy | 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 Renal prognosis of shiga-toxin associated hemolytic uremic syndrome according to dialysis therapy Maud Injeyan, Javier Morelos Zaragoza, Chloé Rousseau, Gwenaelle Roussey, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7244361/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective The aim of this study was to investigate the renal prognosis at one year in Shiga toxin–associated hemolytic uremic syndrome (STEC-HUS) based on the type of kidney replacement therapy (KRT): peritoneal dialysis (PD) versus continuous kidney replacement therapy (CKRT). Method We performed a retrospective study, in 4 French PICUs over a 3-year period: 2018 to 2020. Patients aged less than 16 years-old hospitalized for STEC-HUS and requiring KRT. Measurements and Main Results: 45 patients were included, 29 treated with PD and 16 with CKRT. Patients in the PD group were younger (3 vs 5.5 years; p < .05), had a lower HUS severity score (15.1 vs 16.9; p < .05), and a lower hemoglobin level at admission (9.2 vs 10.6g/dL; p < .05) compared to the CKRT group. The parameters that differed between the groups were adjusted for multivariate analysis. We observed a higher GFR at one year in the PD group compared to the CKRT group (127 vs 99.1ml/min/1.73m²; P = .0001). For the secondary outcomes, results have shown a significantly higher number of red blood cells (RBCs) transfusions (p < .05) in the CKRT group, but no difference for the other outcomes. Conclusions These results suggest that PD may be associated with a better renal prognosis at 1 year and less red blood cell transfusions in patients with STEC-HUS. kidney replacement therapy renal prognosis peritoneal dialysis continuous kidney replacement therapy typical hemolytic uremic syndrome Figures Figure 1 Figure 2 BACKGROUND Hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy defined by mechanical hemolytic anemia, thrombocytopenia and acute kidney injury (AKI) [1]. Atypical HUS accounts for 5% of pediatric cases of HUS and is typically caused by genetic anomalies in complement regulatory proteins. Post-diarrheal HUS, secondary to infection by Shiga-toxin producing Escherichia Coli (STEC-HUS), accounts for 95% of HUS in children [1, 2]. Incidence rate of STEC-HUS is 1 case per 100 000 children-years with a median of 116 cases per year in France [3]. STEC- HUS is the leading cause of AKI in children under 3 years-old and may involve other organs (neurologic, cardiac, hepatic and pancreatic failure). More than half of the patients require kidney replacement therapy (KRT), 1 to 3% die, and 30% experience renal sequelae at one year [4]. Garg et al, in a systematic review, have shown that central nervous system involvement and the need for initial KRT are strongly associated with a worse long-term renal prognosis [5]. The management of STEC-HUS remains supportive: red blood cells (RBCs) transfusion for poorly tolerated anemia, intravenous rehydration or volume expansion, anti-hypertensive treatment and other [6]. KRT indications in cases of AKI in STEC-HUS are mainly fluid overload, oligo-anuria, hydro electrolytic disorders and acidosis [6, 7]. There are two main techniques: peritoneal dialysis (PD) and continuous kidney replacement therapies (CKRT), which include continuous veno-venous hemofiltration (CVVHF) and hemodiafiltration (CVVHDF). Choice of KRT is guided by the patient's age, hemodynamic status, degree of emergency, and also practices within each PICU [8, 9]. Each of these methods has advantages and disadvantages. PD is used more frequently in pediatrics than in adults [9]. The main complications are the risks associated with surgical insertion of peritoneal devices (particularly hemorrhage in thrombocytopenic children) and infectious risks (peritonitis) [6, 10]. In order to improve tolerance, dialysis is started at a low rate and the dialysis target is only reached after a few hours or even days. Therefore, it is not suitable for metabolic emergencies, or in cases of peritoneal involvement of the disease [8]. CKRT, based on diffusion (hemodialysis), convection (hemofiltration) or both (hemodiafiltration), allows rapid correction of electrolyte disorders. But it requires insertion of a venous central catheter in thrombocytopenic patients with a risk of thrombotic or hemorrhagic complication, even though anticoagulation with heparin is used less frequently thanks to calcium citrate dialysis techniques in hemofiltration method [8, 9]. PD has long been preferred because of its ease of use in cases of primary kidney disease, such as HUS [10, 11]. It preserves residual diuresis, and avoids the need for a venous approach in patients with a risk of developing chronic kidney disease (CKD) [9, 12]. There is no recommendation about using PD or CKRT in any AKI in PICU according to the European and French guidelines [12]. Bitzan et al have described a review of 38 pediatric STEC-HUS patients requiring dialysis, the results showed an older population in CKRT and intermittent hemodialysis (IHD) group compared to PD group and who received more platelets transfusion [6]. Unfortunately, there are no studies looking at the choice of technique and the long-term renal prognosis of patients with HUS. The main objective of this study was to investigate the kidney recovery of patients with STEC-HUS according to the dialysis technique used (PD versus CKRT) in PICU. PATIENTS AND METHODS 1. Inclusion and exclusion criteria Patients under 16 years of age, hospitalized for STEC-HUS and requiring KRT over the period 01/01/2018 to 31/12/2020 in the university hospital centers of Brest, Nantes, Rennes and Tours were included. Exclusion criteria were patients with a diagnosis of atypical HUS defined by evidence of an acquired or genetic abnormality of the alternative complement pathway, a metabolic abnormality or of drug origin. We also excluded those for whom we were unable to collect creatinine levels at 1 year. 2. Definitions and data collection Data were collected retrospectively from medical chart and were then anonymized. A letter of information and non-objection was sent to the families, in agreement with French law on non-interventional studies [ 13 ]. The study received a favorable opinion from the local ethics committee. Typical HUS was defined by the association of mechanical hemolytic anemia (Hb < 10 g/dL with schizocytes ≥ 2%), thrombocytopenia (platelets 60 µmol/L for children under 2 years and > 75 µmol/L for children over 2 years) and a digestive history within 3 weeks prior to the declaration of the diagnostic triad and/or the detection of verotoxin in the stools samples. We used the definitions of HUS from the Santé Publique France registry [ 3 ]. The main data collected were demographic data (age, sex, center of origin), biological data at admission (hemoglobin level, neutrophil count, platelet count, glomerular filtration rate (GFR) and proteinuria (defined by > 20 mg/mmol creatinine ratio)), clinical data (oligo-anuria defined as diuresis of less than 0.5ml/kg/h for more than 12 hours, and severity scores; PIM3 [ 15 ], HUS Severity Score (HSS) [ 16 – 18 ] and pRIFLE [ 19 ], clinical data relating to extra-kidney manifestations (neurological injury: diagnosed MRI (Magnetic Resonance Imaging) and/or EEG (Electroencephalogram), and convulsions defined by the use of an anti-seizure treatment, pancreatic injury (lipase > 3N), cardiac injury: left ventricular dysfunction diagnosed on transthoracic echocardiography, and liver damage (cytolysis was defined by ASAT and/or ALAT > 3N)), data on therapeutic management: modality and duration of nutritional support, and use of antihypertensive, plasmapheresis, and eculizumab treatment. 3. Endpoints The primary endpoint was kidney function at 1 year, assessed by GFR estimated by the 2009 Schwartz formula [(Height (cm) x 36.5) / Serum creatinine (sCr) (µmol/L)] [ 20 ]. The secondary endpoints were GFR at 1 month, KRT need at 1 month, hypertension at 1 year (defined by the need for anti-hypertensive treatment), the need for anti-proteinuria treatment at 1 year, length of stay in PICU, duration of KRT, the occurrence or non-occurrence of a KRT complication (CKRT: systemic infection, severe bleeding, hemodynamic instability, switch for technique failure and for PD: bleeding, peritonitis, catheter surgical revision, switch for technique failure), and number of transfusions (platelets or RBCs). 4. Statistical analysis The groups were compared using parametric Student's t test or nonparametric Mann-Whitney Wilcoxon test when appropriated for quantitative variables. For qualitative variables, groups were compared using a parametric χ2 test or a non-parametric Fisher test. Endpoints were compared between groups adjusting for center, age, hemoglobin and HUS score. Quantitative endpoints were analyzed using an ANOVA, or an ANOVA on ranks if normality was not respected, and qualitative endpoints using logistic regression. Analyses were performed using SAS software, version 9.4. RESULTS 1. Description of the population Over the study period, 107 patients were hospitalized with a diagnosis of STEC-HUS and 50 patients were eligible for inclusion. Among the 50 patients requiring dialysis, 5 patients were excluded because sCr levels were not available at 1 year (flow chart, Fig. 1 ). Among 45 patients included, 29 (64.5%) required PD and 16 (35.5%) required CKRT (7 CVVHDF, 9 CVVHF). The median age was 3 years (2–6), neurological symptoms occurred in 20 patients (44.4%), one patient died (cardiac failure). The demographic, biological and clinical characteristics of the patients, as well as the therapies used in the acute phase of the disease, are described in Table 1. The populations were significantly different in the two groups for age, center, hemoglobin level at diagnosis and HSS. Table 1 : demographic, clinical and biological data, treatment used at the acute phase of STEC-HUS Demographic data Population (n = 45) PD (n = 29) CKRT (n = 16) p Age, years 3 (2–6) 3 (1–4) 5.5 (2.5-7) < 0.05* Sex, F 26 (57.8%) 17 (58.6%) 9 (56.3%) 0.88 M 19 (42.2%) 12 (41.4%) 7 (43.8%) Centers, Nantes 17 (37.8%) 7 (24.1%) 10 (62.5%) < 0.01* Rennes 15 (33.3%) 9 (31%) 6 (37.5%) Brest 7 (15.6%) 7 (24.1%) 0 (0.0%) Tours 6 (13.3%) 6 (20.7%) 0 (0.0%) Clinical and biological data at diagnosis Hemoglobin, g/dL 9.5 (7.8–11.4) 9.2 (7.5–10.5) 10.6 (8.8–12.7) < 0.05* Platelet, x10 9 /L 48 (35–66) 46 (37–66) 50.5 (32-85.5) 0.88 GFR (ml/min/1.73m²) 18.3 (9-27.5) 18.8 (9.2–24.7) 17.6 (8.8–38.2) 0.80 Leukocytes x10 9 /L 16.9 (14.1–21) 16.9 (14.5–18.4) 17.3 (12.7–23.6) 0.64 HUS severity score 15.4 (13.3–17) 15.1 (13.1–16.4) 16.9 (14.4–18.8) < 0.05* pRIFLE, R 1 (2.2%) 1 (3.4%) 0 (0%) 1 I 1 (2.2%) 1 (3.4%) 0 (0%) F 43 (95.6%) 27 (93.1%) 16 (100%) PIM3 1.4 (1.2–2.1) 1.5 (1.2–2.2) 1.4 (1.3–2.1) 0.95 Death 1 (2.2%) 0 (0.0%) 1 (6.3%) 0.35 Extra-kidney damage Neurological injury 20 (44.4%) 12 (41.4%) 8 (50%) 0.58 Liver damage 37 (82.2%) 24 (82.8%) 13 (81.3%) 1 Pancreatic damage 17 (37.8%) 11 (37.9%) 6 (37.5%) 0.98 Cardiac injury 5 (11.1%) 3 (10.3%) 2 (12.5%) 1 Treatment Enteral nutrition (EN) 14 (31.1%) 10 (34.5%) 4 (25.0%) 0.74 Duration of EN 24 (15–30) 15 (13–25) 27 (24–60) 0.27 Parenteral nutrition (PN) 17 (37.8%) 14 (48.3%) 3 (18.8%) 0.05 Duration of PN 10 (6–15) 10.5 (5–15) 8 (8–35) 0.66 Antihypertensive 23 (51.1%) 15 (51.7%) 8 (50.0%) 0.91 Eculizumab 15 (33.3%) 9 (31.0%) 6 (37.5%) 0.66 Plasmapheresis 2 (4.4%) 0 (0.0%) 2 (12.5%) 0.12 Qualitative parameters: Number (%). Quantitative parameters: n(NA) median (interquartile Range). *: p < 0.05. PD: peritoneal dialysis, CKRT: continuous kidney replacement therapy, GFR: glomerular filtration rate, HSS: Hemolytic and uremic syndrome Severity Score 2. Primary and secondary endpoints At one year, the median GFR was significantly higher in the PD group compared to the CKRT group in both univariate and multivariate analyses, adjusted for age, center of origin, hemoglobin level, and HSS at admission (Fig. 2 a, Table 2). Patients with a GFR < 90ml/min/1.73m² tended to be fewer in PD than in CKRT group in multivariate analysis with a p value of 0.051 (Fig. 2 b, Table 2). Regarding the secondary endpoints, in the CKRT group 62.5% of patients had a GFR median value < 90ml/min/1.73m² at 1 month versus 13.8% in PD group (p < 0.005) but there was no difference in proteinuria and hypertension at 1 year. There were no differences concerning the length of stay, KRT duration, or KRT complication, but there were more RBCs transfusion in the CKRT group than in the PD group (Table 2). Table 2: endpoints Primary endpoint Population (n = 45) PD (n = 29) CKRT (n = 16) p p* GFR at 1 year < 90 ml/min/1.73m² 7 (15.6%) 1 (3.4%) 6 (37.5%) < 0.01* 0.05 GFR (ml/min/1.73m²) at 1 year 118.3 (101.8–144) 127 (117.2-147.7) 99.1 (84.2-109.3) < 0.0001* < 0.0001* Secondary endpoints GFR at 1 month < 90ml/min/1.73m² 14 (31.1%) 4 (13.8%) 10 (62.5%) < 0.005* < 0.05* Dialysis at 1 month 3 (7.0%) 1 (3.6%) 2 (13.3%) 0.28 0.28 Dialysis at 1 year 0 (0%) 0 (0%) 0 (0%) NA NA Hypertension at 1 year 6 (14.0%) 5 (17.9%) 1 (6.7%) 0.4 0.14 Proteinuria at 1 year 17 (39.5%) 12 (42.9%) 5 (33.3%) 0.54 0.16 Days in PICU 10.5 (7.5–15.5) 11 (8.5–15.5) 9.0 (4.5–15.5) 0.32 0.38 Days on KRT 9 (5–10) 9 (5–12) 9 (5.5–10) 0.85 0.97 Days in hospital 17 (13.5–22.5) 17 (16–22) 14 (12–25) 0.36 0.64 Complications KRT 6 (13.3%) 5 (17.2%) 1 (6.3%) 0.40 0.94 Bleeding 0 (0.0%) 0 (0.0%) 0 (0.0%) NA NA Systemic infection 0 (0.0%) 0 (0.0%) 0 (0.0%) NA NA Peritonitis 1 (2.2%) 1 (3.4%) 0 (0.0%) 1 0.77 Catheter malfunction 4 (8.9%) 4 (13.8%) 0 (0.0%) 0.28 0.77 Switch for technical failure 1 (2.2%) 1 (3.4%) 0 (0.0%) 1 0.91 No transfusion of red blood cells 2 (1–3) 2 (1–3) 3 (2–3) 0.07 < 0.05* Transfusions of platelets needs 29 (65.9%) 20 (69%) 9 (60%) 0.55 0.08 Qualitative parameters: n(NA), Number (%). Quantitative parameters: n(NA) median (IQR). p* value was multivariate analysis adjusted on age, center hemoglobin level and HUS severity score. *: p < 0.05 PD: peritoneal dialysis, CKRT: continuous kidney replacement therapy, GFR: glomerular filtration rate, PICU: pediatric intensive care unit, KRT: kidney replacement therapy, No: number of DISCUSSION Kidney function, as estimated by GFR, at one year is significantly better in patients treated with PD compared to those treated with CKRT for HUS. This study is the first comparing KRT methods in STEC-HUS pediatric patients on renal prognosis. Studies measuring the effect of KRT modality in AKI on long-term renal outcomes are limited and in STEC-HUS did not exist. In a retrospective study compared three techniques of KRT in pediatric cardiac surgery [ 21 ], CKRT was superior to PD for ultrafiltration, solute clearance and nutritional provision, but there was no difference on mortality. Another retrospective study included 226 pediatric patients requiring KRT for any cause, compared IHD, PD and CKRT [ 22 ]. Factors influencing patient survival were low blood pressure at onset of KRT, use of vasopressors, diagnosis and KRT modality (40% survival with CKRT, vs 49% with PD, vs 81% with IHD; P < 0.01 IHD vs PD or CKRT). In conclusion the authors stated than hemodynamic instability was a better predictor of mortality than KRT modalities. The most recent retrospective study was published in 2011, which included 115 patients requiring KRT in PICU [ 23 ], included PD, IHD and CKRT. This study’s results suggest that IHD was associated with a better survival rate (mortality: 8.3% for IHD, 52.2% for PD, 83.3% for CKRT; P < 0.001), but these results could be explained by the presence of more seriously ill patients in the PD and CKRT groups than in the IHD group. Since then, many advances have been made since the 2000s, particularly regarding CKRT, which have led to a clear reduction in hemodynamic instability in children [ 24 ]. HUS is the leading cause of AKI in children under 3 years-old. The increased risk of metabolic disorders (due to hemolysis) and the possible association with multiple organ failure (neurological, cardiac) requiring efficient and rapid ultrafiltration and clearance must be taken into account when choosing the KRT. The hemorrhagic risk of this thrombotic microangiopathy means that the use of anticoagulation is an important part of management. The non-negligible risk of developing chronic kidney disease, makes also essential to preserve venous access. Our results have shown a higher GFR at one year in patients treated with PD for STEC-HUS than in patients treated with CKRT. Several explanations may be proposed by our findings. There was a difference in hemoglobin level and HSS at onset between the two groups. These data have been adjusted for the results, but may reflect a more severe population in the CKRT group. Hemoglobin level can reflect patients’ hydration status and hemoconcentration is known as a poor prognostic factor associated with more neurological and kidney failure [ 16 ]. Balestracci et al reported that dehydrated HUS patients had higher creatinine level at diagnosis, longer-lasting oliguria and need more frequently KRT [ 25 ]. Bonany et al, reported that volume expansion at onset was correlated with la reduced need for dialysis [ 26 ]. Ardissino et al established that a HSS > 13, combining creatine level and hemoglobin, were associated with mortality and CKD [ 27 ]. In another study, HSS > 14.2 was associated with neurological lesions or KRT (sensitivity 80.3%, specificity 73.2%) [ 18 ]. In our study, CKRT group has a higher HSS with a median value at 16.9 and higher hemoglobin level at onset, which may partly explain the poorer renal prognosis. Fluid overload is now known as a morbidity and mortality factor in critically ill children and are associated with increasing risk of AKI [ 28 , 29 ]. Unfortunately, in our study we were unable to measure fluid overload in the context of a retrospective study with different data carriers and therefore a lot of missing data. Furthermore, we compared the length of stay, KRT duration, nutritional support and transfusion according to KRT modalities. Patients in the CKRT group were more likely to receive RBC transfusion, although hemoglobin level at onset were higher in CKRT group. Results were in agreement with the results shown in Bitzan et al’s review, where CKRT was associated with a higher transfusion requirement for RBCs and platelets than PD in STEC-HUS patients [ 6 ]. This finding might be attributed to blood loss associated with extracorporeal circuit complications (circuit clotting without blood return), but we did not was not observe in our study severe bleeding in the CKRT group. There is evidence that nutritional support helps to prevent protein-energy loss, promote healing and tissue repair, support immune system function and reduce mortality [ 30 ], moreover early nutritional support is also an important target for the prevention of peritonitis [ 10 ]. Fleming et al have shown better caloric intake in CKRT than in PD group for patients with congenital heart disease [ 21 ]. Our study has shown a higher need for parenteral nutrition in the PD group (48.3% versus 18.3% in the CKRT group) without significant difference (p = 0.05). Caloric intake is generally limited in patients with STEC-HUS, and can become a challenge in the disease progression. In fact, patients with PD may be less tolerant for enteral nutrition, on the one hand because of the discomfort caused by peritoneal dialysis fluid, and on the other hand because of higher urea levels due to the reduced urea clearance. Studies in critically ill patients showed a reduction in infectious complications, shorter ICU and hospital stay with early enteral nutrition versus parenteral nutrition [ 30 ]. Estimation of GFR in young children is challenging. Indeed, in our study, we could include a measurement bias given the age of the population studied. The Schwartz equation, re-evaluated in 2009, is the formula most widely used in pediatric literature. However, according to some studies, its sensitivity seems unsatisfactory for children under three years old, and especially for those under one year old 31–33 . In pediatrics, can we rely on GFR alone? Pottel and Pierce equations appear to be a good alternative, but are not very comparable to other studies due to their limited use and complexity [ 31 – 33 ]. This data should be analyzed along with other kidney impairments such as proteinuria and hypertension, which are good indicators for renal prognosis of these patients. In our study, at 1 year follow-up, 15.6% of patients had a GFR < 90ml/min/1.73m², 14% had hypertension and 39.5% proteinuria. These data are comparable to others studies: Garg et al. reported 25% of patients with long-term kidney damage, (15.8% with an eGFR < 80ml/min/1.73m², 10% with hypertension and 15% with proteinuria) [ 5 ]. Monet Didailler et al. reported 44% of kidney damage (low GFR, proteinuria and/or hypertension) at 1 year [ 34 ]. The review by Spinale et al. reported long term kidney damage (more than 5 years follow up), such as proteinuria (15–30% of cases), hypertension (5–15%), CKD (9–18%), and end-stage kidney disease (3%) [ 35 ]. Concerning the 1-year GFR evaluation, the literature has shown that it has weaknesses in predicting long-term kidney damage. Indeed, some patients with complete renal recovery at 1 year can develop hypertension, proteinuria or a low GFR over the years [ 34 , 36 ]. In this study, we highlighted differences in the use of techniques between the center according to the resources and expertise of each center. PD has the advantage of being inexpensive and easy to use, making it accessible to PICU with low recruitment. Some PICUs choose to use PD as a priority for patients with AKI due to primary kidney disease, such as STEC-HUS. Other PICUs choose KRT modality according to patient’s severity and the emergency to treat. Moreover, in our study, KRT is sometimes prescribed by nephro-pediatricians and sometimes by intensivists. We were not able to identify determinants of the choice of KRT modality. These data make it difficult to homogenize dialysis modalities, but they do reflect the realities of French centers. In fact, according to the latest 2015 recommendations, for any confounding cause of AKI, KRT techniques, continuous and intermittent, diffusive or convective can be used indifferently, taking into account the availability of the technique and the experience of the team 9 . Effect of KRT modality on long term renal prognosis suggested by our study should be confirmed in a powered prospective randomized clinical trial with standardization of patient severity. CONCLUSION Considering the limitations of this study, our results suggest that PD may be slightly more effective than CKRT in preventing long-term kidney damage in children with STEC HUS. Prospective randomized trials using a uniform disease severity score and standardized criteria for initiation of a particular KRT are needed to assess the impact of different KRT modalities on long-term outcomes in children with STEC HUS. Declarations Funding : The authors did not receive support from any organization for the submitted work. Conflict of interest: The authors declare that they have no competing interest to disclose. Data availability: All data generated or analyzed during this study are included in this published article. Authors’ contributions: All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Maud Injeyan], [Javier Morelos Zaragoza] and [Chloé Rousseau]. The first draft of the manuscript was written by [Maud Injeyan] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Ethics approval: Ethical approval was waived by the local Ethics Committee of the Le Mans Hospital University (N ° CHM-2021/S26/01), in view of the retrospective nature of the study and all the procedures being performed were part of the routine care. Consent to participate: A letter of information and non-objection was sent to guardian legal, in agreement with French law on non-interventional studies. A cknowledgment: We would like to thank Dr Jay at the university hospital center in Brest, Dr Cloarec at the university hospital center in Tours and Dr Ryckewaert at the university hospital center in Rennes for their help with data collection. Thank you for your valuable time. References Tarr PI, Gordon CA, Chandler WL (2005) Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet 365(9464):1073–1086. https://doi.org/10.1016/S0140-6736(05)71144-2 Fakhouri F, Zuber J, Frémeaux-Bacchi V, Loirat C (2017) Haemolytic uraemic syndrome. 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Pediatr Nephrol 36(11):3777–3783. https://doi.org/10.1007/s00467-021-05108-6 Bresolin N, Bianchini AP, Haas CA (2013) Pediatric acute kidney injury assessed by pRIFLE as a prognostic factor in the intensive care unit. Pediatr Nephrol 28(3):485–492. https://doi.org/10.1007/s00467-012-2357-8 Schwartz GJ, Muñoz A, Schneider MF et al (2009) New Equations to Estimate GFR in Children with CKD. JASN 20(3):629–637. https://doi.org/10.1681/ASN.2008030287 Fleming F, Bohn D, Edwards H et al (1995) Renal replacement therapy after repair of congenital heart disease in children. J Thorac Cardiovasc Surg 109(2):322–331. https://doi.org/10.1016/S0022-5223(95)70394-2 Bunchman TE, McBryde KD, Mottes TE et al (2001) Pediatric acute renal failure: outcome by modality and disease. Pediatr Nephrol 16(12):1067–1071. https://doi.org/10.1007/s004670100029 Krause I, Herman N, Cleper R et al (2011) Impact of Dialysis Type on Outcome of Acute Renal Failure in Children: A Single-Center Experience. Isr Med Assoc J 13(3):153–156 De Galasso L, Picca S, Guzzo I (2020) Dialysis modalities for the management of pediatric acute kidney injury. Pediatr Nephrol 35(5):753–765. https://doi.org/10.1007/s00467-019-04213-x Balestracci A, Martin SM, Toledo I et al (2012) Dehydration at admission increased the need for dialysis in hemolytic uremic syndrome children. Pediatr Nephrol 27(8):1407–1410. https://doi.org/10.1007/s00467-012-2158-0 Bonany P, Bilkis MD, Iglesias G et al (2021) Fluid restriction versus volume expansion in children with diarrhea-associated HUS: a retrospective observational study. Pediatr Nephrol 36(1):103–109. https://doi.org/10.1007/s00467-020-04673-6 Ardissino G, Tel F, Testa S et al (2018) A simple prognostic index for Shigatoxin-related hemolytic uremic syndrome at onset: data from the ItalKid-HUS network. Eur J Pediatr 177(11):1667–1674. https://doi.org/10.1007/s00431-018-3198-7 Alobaidi R, Morgan C, Basu RK et al (2018) Association Between Fluid Balance and Outcomes in Critically Ill Children: A Systematic Review and Meta-analysis. JAMA Pediatr 172(3):257. https://doi.org/10.1001/jamapediatrics.2017.4540 Cortina G, Daverio M, Demirkol D et al (2023) Continuous renal replacement therapy in neonates and children: what does the pediatrician need to know? An overview from the Critical Care Nephrology Section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Eur J Pediatr 183(2):529–541. https://doi.org/10.1007/s00431-023-05318-0 Fiaccadori E, Sabatino A, Barazzoni R et al (2021) ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease. Clin Nutr 40(4):1644–1668. https://doi.org/10.1016/j.clnu.2021.01.028 Pierce CB, Muñoz A, Ng DK et al (2021) Age- and sex-dependent clinical equations to estimate glomerular filtration rates in children and young adults with chronic kidney disease. Kidney Int 99(4):948–956. https://doi.org/10.1016/j.kint.2020.10.047 Pottel H, Mottaghy FM, Zaman Z et al (2010) On the relationship between glomerular filtration rate and serum creatinine in children. Pediatr Nephrol 25(5):927–934. https://doi.org/10.1007/s00467-009-1389-1 Pottel H, Björk J, Courbebaisse M et al (2021) Development and Validation of a Modified Full Age Spectrum Creatinine-Based Equation to Estimate Glomerular Filtration Rate: A Cross-sectional Analysis of Pooled Data. Ann Intern Med 174(2):183–191 Monet-Didailler C, Godron-Dubrasquet A, Madden I et al (2019) Long-term outcome of diarrhea-associated hemolytic uremic syndrome is poorly related to markers of kidney injury at 1-year follow-up in a population-based cohort. Pediatr Nephrol 34(4):657–662. https://doi.org/10.1007/s00467-018-4131-z Spinale JM, Ruebner RL, Copelovitch L et al (2013) Long-term outcomes of Shiga toxin hemolytic uremic syndrome. Pediatr Nephrol 28(11):2097–2105. https://doi.org/10.1007/s00467-012-2383-6 Oakes RS, Kirkhamm JK, Nelson RD et al (2008) Duration of oliguria and anuria as predictors of chronic renal-related sequelae in post-diarrheal hemolytic uremic syndrome. Pediatr Nephrol 23(8):1303–1308. https://doi.org/10.1007/s00467-008-0799-9 Cite Share Download PDF Status: Posted Version 1 posted 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-7244361","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":493939124,"identity":"80f93784-67e4-4c3c-a6a2-3689469f1f8e","order_by":0,"name":"Maud Injeyan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEUlEQVRIiWNgGAWjYJACCQYDBmYw6wPDAYQwewMRWhhnIGvhOYBdOUQLFDDzEKNFt/2M4Q2Ggjvs/BLJzx7b1NxJbJA+fOxxQUUdA480dj1mZ3KMLRgMnjFLzkgzN8459iyxgS8t3XjGmcMMPHwJ2LUcyDED+uUws8GNBDPp3IbDifvP8JhJ87YdYLDnwe4ws/NvIFrsb6R/k7YEamng4f8mzfsP6DBcWm7AbJHIMZNmBGvhYZPmbWDGo+VZsUUCUIvEmTdlkj3HDhs38LCZSfMcO8yDU8v55I03Pvw5nMzfnr5N4kfNYdkGHuZn0jw1dXK4tIABMGSSGQTQwgefBjCwY+A/QEjNKBgFo2AUjFQAAMVqVVgACJx3AAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-9941-841X","institution":"CHU Rennes: Centre Hospitalier Universitaire de Rennes","correspondingAuthor":true,"prefix":"","firstName":"Maud","middleName":"","lastName":"Injeyan","suffix":""},{"id":493939125,"identity":"84d968eb-d6ca-4654-a165-2856fc5030e3","order_by":1,"name":"Javier Morelos Zaragoza","email":"","orcid":"","institution":"CHU Angers: Centre Hospitalier Universitaire d'Angers","correspondingAuthor":false,"prefix":"","firstName":"Javier","middleName":"Morelos","lastName":"Zaragoza","suffix":""},{"id":493939126,"identity":"17cc1d33-6153-4dac-9fdb-311b499d6ffc","order_by":2,"name":"Chloé Rousseau","email":"","orcid":"","institution":"clinical investigation center 1414; INSERM","correspondingAuthor":false,"prefix":"","firstName":"Chloé","middleName":"","lastName":"Rousseau","suffix":""},{"id":493939127,"identity":"ecf2e65e-a84c-446d-9fcc-93de3a03eafe","order_by":3,"name":"Gwenaelle Roussey","email":"","orcid":"","institution":"CHU Nantes: Centre Hospitalier Universitaire de Nantes","correspondingAuthor":false,"prefix":"","firstName":"Gwenaelle","middleName":"","lastName":"Roussey","suffix":""},{"id":493939128,"identity":"1950ca74-3bf3-4fe6-8d41-77e796a877cf","order_by":4,"name":"Théophile Gaillot","email":"","orcid":"","institution":"CHU Rennes: Centre Hospitalier Universitaire de Rennes","correspondingAuthor":false,"prefix":"","firstName":"Théophile","middleName":"","lastName":"Gaillot","suffix":""},{"id":493939129,"identity":"3a98b31c-51d0-44de-af53-08cdd947b1d9","order_by":5,"name":"Pauline Berneau","email":"","orcid":"","institution":"CHU Rennes: Centre Hospitalier Universitaire de Rennes","correspondingAuthor":false,"prefix":"","firstName":"Pauline","middleName":"","lastName":"Berneau","suffix":""},{"id":493939130,"identity":"3e67d027-49d4-4243-b891-2091ac6ab6b6","order_by":6,"name":"Bruno Ozanne","email":"","orcid":"","institution":"CHU Rennes: Centre Hospitalier Universitaire de Rennes","correspondingAuthor":false,"prefix":"","firstName":"Bruno","middleName":"","lastName":"Ozanne","suffix":""}],"badges":[],"createdAt":"2025-07-29 14:27:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7244361/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7244361/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88411844,"identity":"4314c407-0edc-47a1-9b22-ea35b72abbd8","added_by":"auto","created_at":"2025-08-06 08:28:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":63080,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow chart\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eSTEC HUS: Shiga toxin producing Escherichia Coli associated hemolytic uremic syndrome, PD: peritoneal dialysis, CKRT: continuous kidney replacement therapy, CVVHF: continuous veno-venous hemofiltration, CVVHDF: continuous veno-venous hemodiafiltration.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7244361/v1/c9858ce2879eea4d12207ea2.png"},{"id":88409644,"identity":"15b52119-644c-4465-b5ea-43715b031a63","added_by":"auto","created_at":"2025-08-06 08:20:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":15821,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e2a. Primary outcome.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e2a. Median value of GFR at 1year (ml/min/1.73m²), *: p value adjusted on age, center, hemoglobin level and HUS severity score \u0026lt;0.0001\u003c/p\u003e\n\u003cp\u003eGFR: glomerular filtration rate, PD: peritoneal dialysis, CKRT: continuous kidney replacement therapy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2b: Primary outcome.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e2b. Kidney function at 1 year, number of patient with a GFR\u0026lt;90ml/min/1.73m², no significantly difference in multivariate analysis with a p value=0.051\u003c/p\u003e\n\u003cp\u003eGFR: glomerular filtration rate, PD: peritoneal dialysis, CKRT: continuous kidney replacement therapy\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7244361/v1/94378b3b6063a9ac82954fe8.png"},{"id":96913137,"identity":"db24362a-72ef-452a-8784-5e349e24278a","added_by":"auto","created_at":"2025-11-27 13:53:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":948976,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7244361/v1/f87182ce-4e25-4786-96f2-2064567ff942.pdf"}],"financialInterests":"","formattedTitle":"Renal prognosis of shiga-toxin associated hemolytic uremic syndrome according to dialysis therapy","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eHemolytic uremic syndrome (HUS) is a thrombotic microangiopathy defined by mechanical hemolytic anemia, thrombocytopenia and acute kidney injury (AKI) [1]. Atypical HUS accounts for 5% of pediatric cases of HUS and is typically caused by genetic anomalies in complement regulatory proteins. Post-diarrheal HUS, secondary to infection by Shiga-toxin producing \u003cem\u003eEscherichia Coli\u003c/em\u003e (STEC-HUS), accounts for 95% of HUS in children [1, 2]. Incidence rate of STEC-HUS is 1 case per 100 000 children-years with a median of 116 cases per year in France [3].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSTEC- HUS is the leading cause of AKI in children under 3 years-old and may involve other organs (neurologic, cardiac, hepatic and pancreatic failure). More than half of the patients require kidney replacement therapy (KRT), 1 to 3% die, and 30% experience renal sequelae at one year [4]. Garg et al, in a systematic review, have shown that central nervous system involvement and the need for initial KRT are strongly associated with a worse long-term renal prognosis [5].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe management of STEC-HUS remains supportive: red blood cells (RBCs) transfusion for poorly tolerated anemia, intravenous rehydration or volume expansion, anti-hypertensive treatment and other [6]. KRT indications in cases of AKI in STEC-HUS are mainly fluid overload, oligo-anuria, hydro electrolytic disorders and acidosis [6, 7]. There are two main techniques: peritoneal dialysis (PD) and continuous kidney replacement therapies (CKRT), which include continuous veno-venous hemofiltration (CVVHF) and hemodiafiltration (CVVHDF). Choice of KRT is guided by the patient\u0026apos;s age, hemodynamic status, degree of emergency, and also practices within each PICU [8, 9].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEach of these methods has advantages and disadvantages. PD is used more frequently in pediatrics than in adults [9]. The main complications are the risks associated with surgical insertion of peritoneal devices (particularly hemorrhage in thrombocytopenic children) and infectious risks (peritonitis) [6, 10]. In order to improve tolerance, dialysis is started at a low rate and the dialysis target is only reached after a few hours or even days. Therefore, it is not suitable for metabolic emergencies, or in cases of peritoneal involvement of the disease [8]. CKRT, based on diffusion (hemodialysis), convection (hemofiltration) or both (hemodiafiltration), allows rapid correction of electrolyte disorders. But it requires insertion of a venous central catheter in thrombocytopenic patients with a risk of thrombotic or hemorrhagic complication, even though anticoagulation with heparin is used less frequently thanks to calcium citrate dialysis techniques in hemofiltration method [8, 9].\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePD has long been preferred because of its ease of use in cases of primary kidney disease, such as HUS [10, 11]. It preserves residual diuresis, and avoids the need for a venous approach in patients with a risk of developing chronic kidney disease (CKD) [9, 12]. There is no recommendation about using PD or CKRT in any AKI in PICU according to the European and French guidelines [12]. Bitzan et al have described a review of 38 pediatric STEC-HUS patients requiring dialysis, the results showed an older population in CKRT and intermittent hemodialysis (IHD) group compared to PD group and who received more platelets transfusion [6]. Unfortunately, there are no studies looking at the choice of technique and the long-term renal prognosis of patients with HUS.\u003c/p\u003e\n\u003cp\u003eThe main objective of this study was to investigate the kidney recovery of patients with STEC-HUS according to the dialysis technique used (PD \u003cem\u003eversus\u003c/em\u003e CKRT) in PICU.\u003c/p\u003e"},{"header":"PATIENTS AND METHODS ","content":"\u003ch2 id=\"_Toc198049382\"\u003e1. Inclusion and exclusion criteria\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003ePatients under 16 years of age, hospitalized for STEC-HUS and requiring KRT over the period 01/01/2018 to 31/12/2020 in the university hospital centers of Brest, Nantes, Rennes and Tours were included. Exclusion criteria were patients with a diagnosis of atypical HUS defined by evidence of an acquired or genetic abnormality of the alternative complement pathway, a metabolic abnormality or of drug origin. We also excluded those for whom we were unable to collect creatinine levels at 1 year.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003e2. Definitions and data collection\u003c/h3\u003e\n\u003cp\u003eData were collected retrospectively from medical chart and were then anonymized. A letter of information and non-objection was sent to the families, in agreement with French law on non-interventional studies [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The study received a favorable opinion from the local ethics committee.\u003c/p\u003e\u003cp\u003eTypical HUS was defined by the association of mechanical hemolytic anemia (Hb\u0026thinsp;\u0026lt;\u0026thinsp;10 g/dL with schizocytes\u0026thinsp;\u0026ge;\u0026thinsp;2%), thrombocytopenia (platelets\u0026thinsp;\u0026lt;\u0026thinsp;150 G/L), AKI (creatinine\u0026thinsp;\u0026gt;\u0026thinsp;60 \u0026micro;mol/L for children under 2 years and \u0026gt;\u0026thinsp;75 \u0026micro;mol/L for children over 2 years) and a digestive history within 3 weeks prior to the declaration of the diagnostic triad and/or the detection of verotoxin in the stools samples. We used the definitions of HUS from the \u003cem\u003eSant\u0026eacute; Publique France\u003c/em\u003e registry [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe main data collected were demographic data (age, sex, center of origin), biological data at admission (hemoglobin level, neutrophil count, platelet count, glomerular filtration rate (GFR) and proteinuria (defined by \u0026gt;\u0026thinsp;20 mg/mmol creatinine ratio)), clinical data (oligo-anuria defined as diuresis of less than 0.5ml/kg/h for more than 12 hours, and severity scores; PIM3 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], HUS Severity Score (HSS) [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and pRIFLE [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], clinical data relating to extra-kidney manifestations (neurological injury: diagnosed MRI (Magnetic Resonance Imaging) and/or EEG (Electroencephalogram), and convulsions defined by the use of an anti-seizure treatment, pancreatic injury (lipase\u0026thinsp;\u0026gt;\u0026thinsp;3N), cardiac injury: left ventricular dysfunction diagnosed on transthoracic echocardiography, and liver damage (cytolysis was defined by ASAT and/or ALAT\u0026thinsp;\u0026gt;\u0026thinsp;3N)), data on therapeutic management: modality and duration of nutritional support, and use of antihypertensive, plasmapheresis, and eculizumab treatment.\u003c/p\u003e\n\u003ch3\u003e3. Endpoints\u003c/h3\u003e\n\u003cp\u003eThe primary endpoint was kidney function at 1 year, assessed by GFR estimated by the 2009 Schwartz formula [(Height (cm) x 36.5) / Serum creatinine (sCr) (\u0026micro;mol/L)] [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe secondary endpoints were GFR at 1 month, KRT need at 1 month, hypertension at 1 year (defined by the need for anti-hypertensive treatment), the need for anti-proteinuria treatment at 1 year, length of stay in PICU, duration of KRT, the occurrence or non-occurrence of a KRT complication (CKRT: systemic infection, severe bleeding, hemodynamic instability, switch for technique failure and for PD: bleeding, peritonitis, catheter surgical revision, switch for technique failure), and number of transfusions (platelets or RBCs).\u003c/p\u003e\n\u003ch3\u003e4. Statistical analysis\u003c/h3\u003e\n\u003cp\u003eThe groups were compared using parametric Student's t test or nonparametric Mann-Whitney Wilcoxon test when appropriated for quantitative variables. For qualitative variables, groups were compared using a parametric χ2 test or a non-parametric Fisher test.\u003c/p\u003e\u003cp\u003eEndpoints were compared between groups adjusting for center, age, hemoglobin and HUS score. Quantitative endpoints were analyzed using an ANOVA, or an ANOVA on ranks if normality was not respected, and qualitative endpoints using logistic regression.\u003c/p\u003e\u003cp\u003eAnalyses were performed using SAS software, version 9.4.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003ch3\u003e1. Description of the population\u003c/h3\u003e\n\u003cp\u003eOver the study period, 107 patients were hospitalized with a diagnosis of STEC-HUS and 50 patients were eligible for inclusion. Among the 50 patients requiring dialysis, 5 patients were excluded because sCr levels were not available at 1 year (flow chart, Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eAmong 45 patients included, 29 (64.5%) required PD and 16 (35.5%) required CKRT (7 CVVHDF, 9 CVVHF). The median age was 3 years (2\u0026ndash;6), neurological symptoms occurred in 20 patients (44.4%), one patient died (cardiac failure). The demographic, biological and clinical characteristics of the patients, as well as the therapies used in the acute phase of the disease, are described in Table\u0026nbsp;1. The populations were significantly different in the two groups for age, center, hemoglobin level at diagnosis and HSS.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"5\" style=\"width: 79.2753%;\"\u003e\n \u003cp\u003eTable 1 : demographic, clinical and biological data, treatment used at the acute phase of STEC-HUS\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\" style=\"width: 39.7112%;\"\u003e\n \u003cp\u003eDemographic data Population (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003ePD (n\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003eCKRT (n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eAge, \u003cem\u003eyears\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e3 (2\u0026ndash;6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e3 (1\u0026ndash;4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e5.5 (2.5-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.05*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eSex, F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e26 (57.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e17 (58.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e9 (56.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.88\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e19 (42.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e12 (41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e7 (43.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eCenters, Nantes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e17 (37.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e7 (24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e10 (62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.01*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eRennes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e15 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e9 (31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e6 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eBrest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e7 (15.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e7 (24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eTours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e6 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e6 (20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\" style=\"width: 55.3015%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical and biological data at diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eHemoglobin, \u003cem\u003eg/dL\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e9.5 (7.8\u0026ndash;11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e9.2 (7.5\u0026ndash;10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e10.6 (8.8\u0026ndash;12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.05*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003ePlatelet, \u003cem\u003ex10\u003c/em\u003e\u003csup\u003e\u003cem\u003e9\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e/L\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e48 (35\u0026ndash;66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e46 (37\u0026ndash;66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e50.5 (32-85.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.88\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eGFR \u003cem\u003e(ml/min/1.73m\u0026sup2;)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e18.3 (9-27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e18.8 (9.2\u0026ndash;24.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e17.6 (8.8\u0026ndash;38.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.80\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eLeukocytes \u003cem\u003ex10\u003c/em\u003e\u003csup\u003e\u003cem\u003e9\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e/L\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e16.9 (14.1\u0026ndash;21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e16.9 (14.5\u0026ndash;18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e17.3 (12.7\u0026ndash;23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.64\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eHUS severity score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e15.4 (13.3\u0026ndash;17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e15.1 (13.1\u0026ndash;16.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e16.9 (14.4\u0026ndash;18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.05*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003epRIFLE, R\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e1 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e1 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e43 (95.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e27 (93.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e16 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003ePIM3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e1.4 (1.2\u0026ndash;2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e1.5 (1.2\u0026ndash;2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e1.4 (1.3\u0026ndash;2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.95\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eDeath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e1 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.35\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\" style=\"width: 55.3015%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExtra-kidney damage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eNeurological injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e20 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e12 (41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e8 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.58\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eLiver damage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e37 (82.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e24 (82.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e13 (81.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003ePancreatic damage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e17 (37.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e11 (37.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e6 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.98\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eCardiac injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e5 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e3 (10.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e2 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\" style=\"width: 55.3015%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eEnteral nutrition (EN)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e14 (31.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e10 (34.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e4 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.74\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eDuration of EN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e24 (15\u0026ndash;30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e15 (13\u0026ndash;25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e27 (24\u0026ndash;60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.27\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eParenteral nutrition (PN)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e17 (37.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e14 (48.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e3 (18.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.05\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eDuration of PN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e10 (6\u0026ndash;15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e10.5 (5\u0026ndash;15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e8 (8\u0026ndash;35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.66\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eAntihypertensive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e23 (51.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e15 (51.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e8 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.91\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003eEculizumab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e15 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e9 (31.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e6 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.66\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.2975%;\"\u003e\n \u003cp\u003ePlasmapheresis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.4137%;\"\u003e\n \u003cp\u003e2 (4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.5903%;\"\u003e\n \u003cp\u003e2 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.2364%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.12\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eQualitative parameters: Number (%). Quantitative parameters: n(NA) median (interquartile Range). *: p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003cp\u003ePD: peritoneal dialysis, CKRT: continuous kidney replacement therapy, GFR: glomerular filtration rate, HSS: Hemolytic and uremic syndrome Severity Score\u003c/p\u003e\n\u003ch3\u003e2. Primary and secondary endpoints\u003c/h3\u003e\n\u003cp\u003eAt one year, the median GFR was significantly higher in the PD group compared to the CKRT group in both univariate and multivariate analyses, adjusted for age, center of origin, hemoglobin level, and HSS at admission (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ea, Table 2). Patients with a GFR\u0026thinsp;\u0026lt;\u0026thinsp;90ml/min/1.73m\u0026sup2; tended to be fewer in PD than in CKRT group in multivariate analysis with a p value of 0.051 (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eb, Table\u0026nbsp;2).\u003c/p\u003e\n\u003cp\u003eRegarding the secondary endpoints, in the CKRT group 62.5% of patients had a GFR median value\u0026thinsp;\u0026lt;\u0026thinsp;90ml/min/1.73m\u0026sup2; at 1 month versus 13.8% in PD group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.005) but there was no difference in proteinuria and hypertension at 1 year. There were no differences concerning the length of stay, KRT duration, or KRT complication, but there were more RBCs transfusion in the CKRT group than in the PD group (Table 2).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tabb\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"6\" style=\"width: 70.85%;\"\u003e\n \u003cp\u003eTable\u0026nbsp;2: endpoints\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\" style=\"width: 37.5259%;\"\u003e\n \u003cp\u003ePrimary endpoint Population (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003ePD (n\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003eCKRT (n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003ep*\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.9207%;\"\u003e\n \u003cp\u003eGFR at 1 year\u0026thinsp;\u0026lt;\u0026thinsp;90 ml/min/1.73m\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6052%;\"\u003e\n \u003cp\u003e7 (15.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003e1 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003e6 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.01*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.05\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.9207%;\"\u003e\n \u003cp\u003eGFR (ml/min/1.73m\u0026sup2;) at 1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6052%;\"\u003e\n \u003cp\u003e118.3 (101.8\u0026ndash;144)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003e127 (117.2-147.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003e99.1 (84.2-109.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\" style=\"width: 49.8413%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary endpoints\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.9207%;\"\u003e\n \u003cp\u003eGFR at 1 month\u0026thinsp;\u0026lt;\u0026thinsp;90ml/min/1.73m\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6052%;\"\u003e\n \u003cp\u003e14 (31.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003e4 (13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003e10 (62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.005*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.05*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.9207%;\"\u003e\n \u003cp\u003eDialysis at 1 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6052%;\"\u003e\n \u003cp\u003e3 (7.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003e1 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003e2 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.28\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.28\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.9207%;\"\u003e\n \u003cp\u003eDialysis at 1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6052%;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003eNA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003eNA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.9207%;\"\u003e\n \u003cp\u003eHypertension at 1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6052%;\"\u003e\n \u003cp\u003e6 (14.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003e5 (17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003e1 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.4\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.14\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.9207%;\"\u003e\n \u003cp\u003eProteinuria at 1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6052%;\"\u003e\n \u003cp\u003e17 (39.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003e12 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003e5 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.54\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.16\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.9207%;\"\u003e\n \u003cp\u003eDays in PICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6052%;\"\u003e\n \u003cp\u003e10.5 (7.5\u0026ndash;15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003e11 (8.5\u0026ndash;15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003e9.0 (4.5\u0026ndash;15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.32\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.38\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.9207%;\"\u003e\n \u003cp\u003eDays on KRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6052%;\"\u003e\n \u003cp\u003e9 (5\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003e9 (5\u0026ndash;12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003e9 (5.5\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.85\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.97\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.9207%;\"\u003e\n \u003cp\u003eDays in hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6052%;\"\u003e\n \u003cp\u003e17 (13.5\u0026ndash;22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003e17 (16\u0026ndash;22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003e14 (12\u0026ndash;25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.36\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.64\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.9207%;\"\u003e\n \u003cp\u003eComplications KRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6052%;\"\u003e\n \u003cp\u003e6 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003e5 (17.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003e1 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.40\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.94\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.9207%;\"\u003e\n \u003cp\u003eBleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6052%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003eNA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003eNA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.9207%;\"\u003e\n \u003cp\u003eSystemic infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6052%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003eNA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003eNA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.9207%;\"\u003e\n \u003cp\u003ePeritonitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6052%;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003e1 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.77\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.9207%;\"\u003e\n \u003cp\u003eCatheter malfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6052%;\"\u003e\n \u003cp\u003e4 (8.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003e4 (13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.28\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.77\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.9207%;\"\u003e\n \u003cp\u003eSwitch for technical failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6052%;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003e1 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.91\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.9207%;\"\u003e\n \u003cp\u003eNo transfusion of red blood cells\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6052%;\"\u003e\n \u003cp\u003e2 (1\u0026ndash;3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003e2 (1\u0026ndash;3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003e3 (2\u0026ndash;3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.07\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.05*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 24.9207%;\"\u003e\n \u003cp\u003eTransfusions of platelets needs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6052%;\"\u003e\n \u003cp\u003e29 (65.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.3154%;\"\u003e\n \u003cp\u003e20 (69%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.1706%;\"\u003e\n \u003cp\u003e9 (60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.55\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.983%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.08\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eQualitative parameters: n(NA), Number (%). Quantitative parameters: n(NA) median (IQR).\u003c/p\u003e\n\u003cp\u003ep* value was multivariate analysis adjusted on age, center hemoglobin level and HUS severity score. *: p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n\u003cp\u003ePD: peritoneal dialysis, CKRT: continuous kidney replacement therapy, GFR: glomerular filtration rate, PICU: pediatric intensive care unit, KRT: kidney replacement therapy, No: number of\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eKidney function, as estimated by GFR, at one year is significantly better in patients treated with PD compared to those treated with CKRT for HUS. This study is the first comparing KRT methods in STEC-HUS pediatric patients on renal prognosis.\u003c/p\u003e\u003cp\u003eStudies measuring the effect of KRT modality in AKI on long-term renal outcomes are limited and in STEC-HUS did not exist. In a retrospective study compared three techniques of KRT in pediatric cardiac surgery [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], CKRT was superior to PD for ultrafiltration, solute clearance and nutritional provision, but there was no difference on mortality.\u003c/p\u003e\u003cp\u003eAnother retrospective study included 226 pediatric patients requiring KRT for any cause, compared IHD, PD and CKRT [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Factors influencing patient survival were low blood pressure at onset of KRT, use of vasopressors, diagnosis and KRT modality (40% survival with CKRT, vs 49% with PD, vs 81% with IHD; P\u0026thinsp;\u0026lt;\u0026thinsp;0.01 IHD vs PD or CKRT). In conclusion the authors stated than hemodynamic instability was a better predictor of mortality than KRT modalities. The most recent retrospective study was published in 2011, which included 115 patients requiring KRT in PICU [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], included PD, IHD and CKRT. This study\u0026rsquo;s results suggest that IHD was associated with a better survival rate (mortality: 8.3% for IHD, 52.2% for PD, 83.3% for CKRT; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), but these results could be explained by the presence of more seriously ill patients in the PD and CKRT groups than in the IHD group.\u003c/p\u003e\u003cp\u003eSince then, many advances have been made since the 2000s, particularly regarding CKRT, which have led to a clear reduction in hemodynamic instability in children [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHUS is the leading cause of AKI in children under 3 years-old. The increased risk of metabolic disorders (due to hemolysis) and the possible association with multiple organ failure (neurological, cardiac) requiring efficient and rapid ultrafiltration and clearance must be taken into account when choosing the KRT. The hemorrhagic risk of this thrombotic microangiopathy means that the use of anticoagulation is an important part of management. The non-negligible risk of developing chronic kidney disease, makes also essential to preserve venous access.\u003c/p\u003e\u003cp\u003eOur results have shown a higher GFR at one year in patients treated with PD for STEC-HUS than in patients treated with CKRT. Several explanations may be proposed by our findings. There was a difference in hemoglobin level and HSS at onset between the two groups. These data have been adjusted for the results, but may reflect a more severe population in the CKRT group.\u003c/p\u003e\u003cp\u003eHemoglobin level can reflect patients\u0026rsquo; hydration status and hemoconcentration is known as a poor prognostic factor associated with more neurological and kidney failure [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Balestracci et al reported that dehydrated HUS patients had higher creatinine level at diagnosis, longer-lasting oliguria and need more frequently KRT [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Bonany et al, reported that volume expansion at onset was correlated with la reduced need for dialysis [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Ardissino et al established that a HSS\u0026thinsp;\u0026gt;\u0026thinsp;13, combining creatine level and hemoglobin, were associated with mortality and CKD [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In another study, HSS\u0026thinsp;\u0026gt;\u0026thinsp;14.2 was associated with neurological lesions or KRT (sensitivity 80.3%, specificity 73.2%) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In our study, CKRT group has a higher HSS with a median value at 16.9 and higher hemoglobin level at onset, which may partly explain the poorer renal prognosis.\u003c/p\u003e\u003cp\u003eFluid overload is now known as a morbidity and mortality factor in critically ill children and are associated with increasing risk of AKI [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Unfortunately, in our study we were unable to measure fluid overload in the context of a retrospective study with different data carriers and therefore a lot of missing data.\u003c/p\u003e\u003cp\u003eFurthermore, we compared the length of stay, KRT duration, nutritional support and transfusion according to KRT modalities.\u003c/p\u003e\u003cp\u003ePatients in the CKRT group were more likely to receive RBC transfusion, although hemoglobin level at onset were higher in CKRT group. Results were in agreement with the results shown in Bitzan et al\u0026rsquo;s review, where CKRT was associated with a higher transfusion requirement for RBCs and platelets than PD in STEC-HUS patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This finding might be attributed to blood loss associated with extracorporeal circuit complications (circuit clotting without blood return), but we did not was not observe in our study severe bleeding in the CKRT group.\u003c/p\u003e\u003cp\u003eThere is evidence that nutritional support helps to prevent protein-energy loss, promote healing and tissue repair, support immune system function and reduce mortality [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], moreover early nutritional support is also an important target for the prevention of peritonitis [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Fleming et al have shown better caloric intake in CKRT than in PD group for patients with congenital heart disease [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Our study has shown a higher need for parenteral nutrition in the PD group (48.3% versus 18.3% in the CKRT group) without significant difference (p\u0026thinsp;=\u0026thinsp;0.05). Caloric intake is generally limited in patients with STEC-HUS, and can become a challenge in the disease progression. In fact, patients with PD may be less tolerant for enteral nutrition, on the one hand because of the discomfort caused by peritoneal dialysis fluid, and on the other hand because of higher urea levels due to the reduced urea clearance. Studies in critically ill patients showed a reduction in infectious complications, shorter ICU and hospital stay with early enteral nutrition versus parenteral nutrition [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEstimation of GFR in young children is challenging. Indeed, in our study, we could include a measurement bias given the age of the population studied. The Schwartz equation, re-evaluated in 2009, is the formula most widely used in pediatric literature. However, according to some studies, its sensitivity seems unsatisfactory for children under three years old, and especially for those under one year old\u003csup\u003e31\u0026ndash;33\u003c/sup\u003e. In pediatrics, can we rely on GFR alone? Pottel and Pierce equations appear to be a good alternative, but are not very comparable to other studies due to their limited use and complexity [\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. This data should be analyzed along with other kidney impairments such as proteinuria and hypertension, which are good indicators for renal prognosis of these patients.\u003c/p\u003e\u003cp\u003eIn our study, at 1 year follow-up, 15.6% of patients had a GFR\u0026thinsp;\u0026lt;\u0026thinsp;90ml/min/1.73m\u0026sup2;, 14% had hypertension and 39.5% proteinuria. These data are comparable to others studies: Garg et al. reported 25% of patients with long-term kidney damage, (15.8% with an eGFR\u0026thinsp;\u0026lt;\u0026thinsp;80ml/min/1.73m\u0026sup2;, 10% with hypertension and 15% with proteinuria) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Monet Didailler et al. reported 44% of kidney damage (low GFR, proteinuria and/or hypertension) at 1 year [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The review by Spinale et al. reported long term kidney damage (more than 5 years follow up), such as proteinuria (15\u0026ndash;30% of cases), hypertension (5\u0026ndash;15%), CKD (9\u0026ndash;18%), and end-stage kidney disease (3%) [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eConcerning the 1-year GFR evaluation, the literature has shown that it has weaknesses in predicting long-term kidney damage. Indeed, some patients with complete renal recovery at 1 year can develop hypertension, proteinuria or a low GFR over the years [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this study, we highlighted differences in the use of techniques between the center according to the resources and expertise of each center. PD has the advantage of being inexpensive and easy to use, making it accessible to PICU with low recruitment. Some PICUs choose to use PD as a priority for patients with AKI due to primary kidney disease, such as STEC-HUS. Other PICUs choose KRT modality according to patient\u0026rsquo;s severity and the emergency to treat. Moreover, in our study, KRT is sometimes prescribed by nephro-pediatricians and sometimes by intensivists. We were not able to identify determinants of the choice of KRT modality. These data make it difficult to homogenize dialysis modalities, but they do reflect the realities of French centers. In fact, according to the latest 2015 recommendations, for any confounding cause of AKI, KRT techniques, continuous and intermittent, diffusive or convective can be used indifferently, taking into account the availability of the technique and the experience of the team\u003csup\u003e9\u003c/sup\u003e. Effect of KRT modality on long term renal prognosis suggested by our study should be confirmed in a powered prospective randomized clinical trial with standardization of patient severity.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eConsidering the limitations of this study, our results suggest that PD may be slightly more effective than CKRT in preventing long-term kidney damage in children with STEC HUS. Prospective randomized trials using a uniform disease severity score and standardized criteria for initiation of a particular KRT are needed to assess the impact of different KRT modalities on long-term outcomes in children with STEC HUS.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: The authors did not receive support from any organization for the submitted work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e All data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u0026nbsp;\u003c/strong\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Maud Injeyan], [Javier Morelos Zaragoza] and [Chlo\u0026eacute; Rousseau]. The first draft of the manuscript was written by [Maud Injeyan] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u0026nbsp;\u003c/strong\u003eEthical approval was waived by the local Ethics Committee of the Le Mans Hospital University (N \u0026deg; CHM-2021/S26/01), in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eA letter of information and non-objection was sent to guardian legal, in agreement with French law on non-interventional studies.\u003c/p\u003e\n\u003cp id=\"_Toc198049392\"\u003e\u003cstrong\u003eA\u003c/strong\u003e\u003cstrong\u003ecknowledgment:\u003c/strong\u003e We would like to thank Dr Jay at the university hospital center in Brest, Dr Cloarec at the university hospital center in Tours and Dr Ryckewaert at the university hospital center in Rennes for their help with data collection. Thank you for your valuable time.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTarr PI, Gordon CA, Chandler WL (2005) Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet 365(9464):1073\u0026ndash;1086. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(05)71144-2\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(05)71144-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFakhouri F, Zuber J, Fr\u0026eacute;meaux-Bacchi V, Loirat C (2017) Haemolytic uraemic syndrome. 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Pediatr Nephrol 23(8):1303\u0026ndash;1308. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00467-008-0799-9\u003c/span\u003e\u003cspan address=\"10.1007/s00467-008-0799-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"kidney replacement therapy, renal prognosis, peritoneal dialysis, continuous kidney replacement therapy, typical hemolytic uremic syndrome","lastPublishedDoi":"10.21203/rs.3.rs-7244361/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7244361/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThe aim of this study was to investigate the renal prognosis at one year in Shiga toxin\u0026ndash;associated hemolytic uremic syndrome (STEC-HUS) based on the type of kidney replacement therapy (KRT): peritoneal dialysis (PD) versus continuous kidney replacement therapy (CKRT).\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eWe performed a retrospective study, in 4 French PICUs over a 3-year period: 2018 to 2020. Patients aged less than 16 years-old hospitalized for STEC-HUS and requiring KRT.\u003c/p\u003e\u003ch2\u003eMeasurements and Main Results:\u003c/h2\u003e\u003cp\u003e45 patients were included, 29 treated with PD and 16 with CKRT. Patients in the PD group were younger (3 vs 5.5 years; p\u0026thinsp;\u0026lt;\u0026thinsp;.05), had a lower HUS severity score (15.1 vs 16.9; p\u0026thinsp;\u0026lt;\u0026thinsp;.05), and a lower hemoglobin level at admission (9.2 vs 10.6g/dL; p\u0026thinsp;\u0026lt;\u0026thinsp;.05) compared to the CKRT group. The parameters that differed between the groups were adjusted for multivariate analysis. We observed a higher GFR at one year in the PD group compared to the CKRT group (127 vs 99.1ml/min/1.73m\u0026sup2;; P\u0026thinsp;=\u0026thinsp;.0001). For the secondary outcomes, results have shown a significantly higher number of red blood cells (RBCs) transfusions (p\u0026thinsp;\u0026lt;\u0026thinsp;.05) in the CKRT group, but no difference for the other outcomes.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThese results suggest that PD may be associated with a better renal prognosis at 1 year and less red blood cell transfusions in patients with STEC-HUS.\u003c/p\u003e","manuscriptTitle":"Renal prognosis of shiga-toxin associated hemolytic uremic syndrome according to dialysis therapy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-06 08:20:04","doi":"10.21203/rs.3.rs-7244361/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"66374a3f-3177-4ead-9ccf-e0ebaa926f45","owner":[],"postedDate":"August 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-22T16:17:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-06 08:20:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7244361","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7244361","identity":"rs-7244361","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}