Pediatric Nephrology

, Volume 31, Issue 4, pp 651–659 | Cite as

Continuous renal replacement therapy in children: fluid overload does not always predict mortality

  • Lara de GalassoEmail author
  • Francesco Emma
  • Stefano Picca
  • Matteo Di Nardo
  • Emanuele Rossetti
  • Isabella Guzzo
Original Article



Mortality among critically ill children requiring continuous renal replacement therapy (CRRT) is high. Several factors have been identified as outcome predictors. Many studies have specifically reported a positive association between the fluid overload at CRRT initiation and the mortality of critically ill pediatric patients.


This study is a retrospective single-center analysis including all patients admitted to the pediatric intensive care unit (PICU) of our hospital who received CRRT between 2000 and 2012. One hundred thirty-one patients were identified and subsequently classified according to primary disease. Survival rates, severity of illness and fluid balance differed among subgroups. The primary outcome was patient survival to PICU discharge.


Overall survival to PICU discharge was 45.8 %. Based on multiple regression analysis, mortality was independently associated with onco-hematological disease [odds ratio (OR) 11.7, 95 % confidence interval (CI) 1.3–104.7; p = 0.028], severe multiple organ dysfunction syndrome (MODS) (OR 5.1, 95 % CI 1.7–15; p = 0.003) and hypotension (OR 11.6, 95 % CI 1.4–93.2; p = 0.021). In the subgroup analysis, a fluid overload (FO) of more than 10 % (FO>10 %) at the beginning of CRRT seems to be a negative predictor of mortality (OR 10.9, 95 % CI 0.78–152.62; p = 0.07) only in children with milder disease (renal patients). Due to lack of statistical power, the independent effect of fluid overload on mortality could not be analyzed in all subgroups of patients.


In children treated with CRRT the underlying diagnosis and severity of illness are independent risk factors for mortality. The degree of FO is a negative predictor only in patients with milder disease.


Acute renal failure CRRT Fluid overload Multiple organ dysfunction syndrome Underlying diseases Survival 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© IPNA 2015

Authors and Affiliations

  • Lara de Galasso
    • 1
    Email author
  • Francesco Emma
    • 2
  • Stefano Picca
    • 2
  • Matteo Di Nardo
    • 3
  • Emanuele Rossetti
    • 3
  • Isabella Guzzo
    • 2
  1. 1.Nephrology and Dialysis A Unit“Sapienza” University of RomeRomeItaly
  2. 2.Department of Nephrology and UrologyBambino Gesù Children’s Hospital—IRCCSRomeItaly
  3. 3.Pediatric Intensive Care UnitBambino Gesù Children’s Hospital—IRCCSRomeItaly

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