ABSTRACTS from 16th International COnference on ... - CRRT Online

<strong>ABSTRACTS</strong> FROM 17 TH INTERNATIONAL CONFERENCE ON CRRT,
SAN DIEGO, FEB 14-17, 2012
at the initiation of CRRT may be
important parameters to determine the
optimal time for CRRT.
10. Identifying Predictors of Outcome
Following CRRT Discontinuation
in Pediatric ICU Population
Rebecca M Lombel, Heather A Lesage-
Horton, Neal B Blatt, David T Selewski,
Theresa A Mottes, Kassandra L Messer,
Peter X Song, Debbie S Gipson, Michael
Heung
University of Michigan, Ann Arbor, MI,
Background: In critically ill pediatric
patients, renal replacement therapy
(RRT) improves short-term survival in
severe acute kidney injury (AKI), yet
there remains little consensus regarding
timing of initiation or discontinuation of
RRT. Only two studies have specifically
examined predictors of successful
discontinuation of continuous RRT
(CRRT), and neither study included
pediatric patients. We sought to
determine if several readily-available
clinical parameters could predict clinical
outcomes following CRRT
discontinuation. Methods: Retrospective
single-center study of 115 children who
required CRRT in the PICU <strong>from</strong> July
26 to March 211. Data collection
included degree of fluid overload (FO) at
CRRT initiation and discontinuation;
duration of therapy and urine output
(UOP) prior to CRRT discontinuation.
The primary endpoint was patient
outcome following CRRT
discontinuation, defined as dialysis
dependence, dialysis independence or
death. ANOVA was used for normally
distributed data and Kruskal-Wallis tests
for non-normally distributed data.
Multiple logistic regression modeling
was performed. Results: Outcomes
following CRRT discontinuation were as
follows: 32 (28%) patients died, 21
(18%) required intermittent dialysis and
62 (54%) did not require dialysis. In
unadjusted analyses, there were
significant differences between the 3
outcome groups when comparing mean
values of FO at discontinuation (p=.5),
age (p=.3) and length of CRRT (p=.4).
Of 6 clinical parameters, only urine
output in the 8 hours prior to
discontinuation produced significant
results following adjustment; for 1
mL/kg/hour increase in UOP, the OR of
dialysis independence compared to death
was 2. (95% CI 1.2-3.4). Conclusions:
Our study represents a first step in
understanding the characteristics of
pediatric patients with severe AKI that
predict post-CRRT survival and need for
ongoing renal replacement. We
identified that urine output in the 8 hours
preceding CRRT discontinuation was
associated with dialysis-independent
patient survival. Although preliminary,
this finding suggests that readilyavailable
clinical parameters can inform
clinical decision-making about the
timing of CRRT discontinuation, and
provides the rationale for prospective
clinical trials.
11. Pharmacodynamic Properties of
Imipenem in Continuous
Venovenous Hemodialysis
(CVVHD)
Milen Amde, Seth R Bauer, Michael J
Connor, Charbel A Salem, William H
Fissell
Cleveland Clinic, Emory University
Background: Sepsis is the leading cause
of death in acute renal failure and recent
publications highlight the survival
benefit of early appropriate antimicrobial
therapy. We hypothesized that dialytic
clearance of antibiotics might undermine
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