Eighteen years experience in pediatric acute dialysis: analysis of predictors of outcome

This study reviewed the 18-year experience of acute dialysis in the pediatr ic intensive care unit, in order to identify factors that could predict out come, and to determine whether newer modalities of acute dialysis have infl uenced this outcome. Sixty-six children (ages 1 day to 19 years) received a cute dialysis from May 1980 to April 1998. Factors predicting outcome were analyzed using univariate and Cox regression analysis. Modality of dialysis in the first 15 years was exclusively peritoneal dialysis with a mortality of 63.9%. However, in the last 3 years, with increasing patient numbers, c ontinuous hemodiafiltration (CHDF) was the modality of choice (56.7%), with a mortality of 73.3%. Univariate analysis showed that age <1 year, coma, a cute tubular necrosis, disseminated intravascular coagulopathy, assisted ve ntilation, and hypotension were associated significantly with poor outcome (P<0.05). Cox regression analysis revealed that mortality was significantly higher in patients on mechanical ventilation (RR 5.96, 95% CI 1.82-19.50), or with age <1 year (RR 2.00, 95% CI 1.08-3.73). In conclusion, despite th e increasing use of CHDF over the last 3 years, there was no significant im provement in mortality, probably related to the fact that more critically i ll patients were dialyzed.