Pediatric patients with crush syndrome–associated acute kidney injury who experienced a pediatric intensive care unit transfer delay of more than 47 hours had a higher likelihood of dialysis dependency at discharge, according to a recent study. 

Researchers conducted a multicenter cohort study to evaluate kidney replacement therapy (KRT) modalities and outcomes in pediatric patients with crush syndrome–associated acute kidney injury (AKI) following the 2023 Kahramanmaraş earthquake. The prospective and retrospective cohort study, published in JAMA Network Open, analyzed the impact of KRT on dialysis dependency and pediatric intensive care unit (PICU) length of stay (LOS). The analysis was conducted between August and October 2024.

The researchers recruited 183 pediatric patients admitted to 20 PICUs in Turkey. The median age was 158 months (interquartile range [IQR] = 108–192 months), and 54.4% (n = 49) were male. The median time under the rubble was 25.7 hours (IQR = 1–137 hours), and at admission, 56.6% (n = 51) of the patients had stage III AKI. The median serum creatinine phosphokinase level was 15,555 IU/L (IQR = 9,386–59,274 IU/L), and a significant association was observed between Kidney Disease–Improving Global Outcomes stage and creatinine phosphokinase level (area under the curve [AUC] = 0.750, 95% confidence interval [CI] = 0.621–0.879, P < .001).

Among the 90 pediatric patients requiring KRT, 36.7% (n = 33) received continuous venovenous hemodiafiltration, and 25.6% (n = 23) underwent intermittent hemodialysis (IHD). IHD was the only independent factor associated with shorter PICU LOS (odds ratio [OR] = 6.87, 95% CI = 1.54–30.67, P = .01). However, no statistically significant difference in dialysis dependency at discharge was observed between IHD and continuous KRT (OR = 2.18, 95% CI = 0.53–8.98, P = .28).

A delay in PICU transfer beyond 47 hours significantly increased dialysis dependency at discharge (AUC = 0.818, 95% CI = 0.711–0.925, P < .001), and patients with higher Pediatric Trauma Scores were also at elevated risk (beta = 0.022, 95% CI = 0.003–0.041, P = .02). The overall mortality rate was 6.6% (n = 6).

Because delayed PICU transfer and higher Pediatric Trauma Score were independent risk factors for dialysis dependency, timely intensive care in pediatric AKI following crush injuries "may reduce the risk of dialysis dependency and support recovery," the study authors concluded. IHD was independently associated with shorter PICU stays, but no KRT modality was linked to differences in dialysis dependency at discharge.

Full disclosures can be found in the published study.