An epidemiological assessment of hemodialysis, continuous kidney replacement therapy, and peritoneal dialysis in pediatric acute kidney injury patients

Abstract

INTRODUCTION: Hemodialysis (HD), peritoneal dialysis (PD), and continuous kidney replacement therapy (CKRT) are major modalities of kidney replacement therapy (KRT) in pediatric acute kidney injury (AKI). This study uses TriNetX data to identify clinical characteristics of pediatric AKI patients receiving HD, PD, and CKRT and compare outcomes across 30-, 90-, 180-, and 365-day follow-ups. METHODS: = 1,408)]. RESULTS: CKRT patients had higher BUN (19.7 mg/dL) and glucose (136 mg/dL). Intestinal diseases were frequent comorbidities. Hypertension was most common in CKRT (12.1%). Diuretics (12.1%) and epinephrine (11.3%) were the most used medications. At 30 days, mortality was lowest in HD (13.7%) vs PD (14.9%) and CKRT (19.9%). This persisted at 365 days (CKRT 24.2%). Ventilation rates were 22.0% (HD), 23.1% (PD), 25.6% (CKRT). ICU admission was highest in CKRT (71.1%). CONCLUSIONS: CKRT had the greatest ten-year incidence (3.6%) and prevalence (3.8%). HD and PD had lower observed mortality and ICU admission than CKRT, a pattern likely reflecting confounding by indication rather than a causal effect of modality. CKRT patients showed higher comorbidity burden and mortality, emphasizing the need for individualized management in pediatric AKI.