Outcomes of hematopoietic stem cell transplant patients who received continuous renal replacement therapy in a pediatric oncology intensive care unit

Surender Rajasekaran, Deborah P. Jones, Yvonne Avent, Michele L. Shaffer, Lama Elbahlawan, Nan Henderson, Raymond C. Barfield, R. Ray Morrison, Robert F. Tamburro

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

Objectives: To assess the long-term benefits of continuous renal replacement therapy (CRRT) in this patient population and to analyze factors associated with survival. Hematopoietic stem cell transplantation is being utilized as curative therapy for a variety of disorders. However, organ dysfunction is commonly associated with this therapy. Continuous renal replacement therapy (CRRT) is increasingly being used in the treatment of this multiorgan dysfunction. Design: Retrospective cohort study. Setting: A free-standing, tertiary care, pediatric oncology hospital. Patients: Twenty-nine allogeneic hematopoietic stem cell transplantation patients who underwent 33 courses of CRRT in the intensive care unit between January 2003 and December 2007. Interventions: Cox proportional hazards regressions models were used to examine the relationship between demographic and clinical variables and length of survival. Measurements And Main Results: The median length of survival post CRRT initiation was 31 days; only one patient survived >6 mos. Factors associated with increased risk of death included: higher bilirubin and blood urea nitrogen levels before and at 48 hrs into CRRT, lower Pao2/Fio2 ratios at 48 hrs of CRRT, and higher C-reactive protein levels, as well as lower absolute neutrophil counts at CRRT end. Conclusion: In this single-center study, CRRT was not associated with long-term survival in pediatric allogeneic hematopoietic stem cell transplantation patients. Clinical data exist, both before and during CRRT, that may be associated with length of survival. Lower C-reactive protein levels at CRRT end were associated with longer survival, suggesting that the ability to attenuate inflammation during CRRT may afford a survival advantage. These findings require confirmation in a prospective study.

Original languageEnglish (US)
Pages (from-to)699-706
Number of pages8
JournalPediatric Critical Care Medicine
Volume11
Issue number6
DOIs
StatePublished - Nov 2010

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Outcomes of hematopoietic stem cell transplant patients who received continuous renal replacement therapy in a pediatric oncology intensive care unit'. Together they form a unique fingerprint.

  • Cite this

    Rajasekaran, S., Jones, D. P., Avent, Y., Shaffer, M. L., Elbahlawan, L., Henderson, N., Barfield, R. C., Morrison, R. R., & Tamburro, R. F. (2010). Outcomes of hematopoietic stem cell transplant patients who received continuous renal replacement therapy in a pediatric oncology intensive care unit. Pediatric Critical Care Medicine, 11(6), 699-706. https://doi.org/10.1097/PCC.0b013e3181e32423