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Dialysis-dependent acute kidney injury in children with end-stage liver disease: prevalence, dialysis modalities and outcome

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Abstract

Background

Acute kidney injury (AKI) is a major complication in children with hepatic failure which leads to increased morbidity and mortality. The aim of this study was to provide paediatric data on the prevalence of dialysis-dependent AKI (dAKI), the feasibility and efficacy of dialysis methods and outcome.

Methods

We conducted a retrospective analysis of 367 children listed for orthotopic liver transplantation (OLT) in our centre during the past decade.

Results

Data on 30 children (15 boys, 15 girls) were compiled for retrospective analysis, and data on dialysis feasibility and efficacy were available for 26 of these. Median age was 3.5 (range 0.4–17.7) years. Median MELD (Model For End-Stage Liver Disease) score was 33. dAKI was caused by hepato-renal syndrome in 16 of the 30 children. Twenty-one patients were treated with continuous veno-venous haemofiltration (CVVH), and nine patients received peritoneal dialysis (PD). Overall mortality was 77 %. Mortality within the PD-group was 100 % versus 67 % in the CVVH-group (p = 0.039). Urea reduction rate within the first 24 h of treatment was 12.9 % in the PD group and 23.5 % in the CVVH group (p = 0.019).

Conclusions

Children with end-stage liver disease have a high risk for dAKI associated with high mortality. CVVH is associated with better efficacy and less mortality than PD.

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Conflict of interest statement

The authors declare that they have no conflict of interests.

Ethical Approval

The Hannover Medical School Ethics Committee waived the need for specific ethical approval due to the retrospective nature of the analysis and de-personalization of data. All research was performed in compliance with the Helsinki Declaration.

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    Authors and Affiliations

    1. Department of Paediatric Nephrology, Hepatology and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany

      Martin Kreuzer, Dagmar Gähler, Annette C. Rakenius, Jenny Prüfe, Eva-Doreen Pfister & Lars Pape

    2. Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany

      Thomas Jack

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    1. Martin Kreuzer
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    2. Dagmar Gähler
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    3. Annette C. Rakenius
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    Correspondence to Martin Kreuzer.

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    Martin Kreuzer and Dagmar Gähler contributed equally to this work.

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    Kreuzer, M., Gähler, D., Rakenius, A.C. et al. Dialysis-dependent acute kidney injury in children with end-stage liver disease: prevalence, dialysis modalities and outcome. Pediatr Nephrol 30, 2199–2206 (2015). https://doi.org/10.1007/s00467-015-3156-9

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    • DOI: https://doi.org/10.1007/s00467-015-3156-9

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