Haemorrhagic complications in paediatric dialysis-dependent acute kidney injury: Incidence and impact on outcome.

BACKGROUND The occurrence of haemorrhagic complications in children with dialysis-dependent acute kidney injury (dAKI) and its contribution to morbidity and mortality is unclear. The objective of this retrospective analysis was to investigate the dialysis modalities, haemorrhagic complications and outcome of dAKI in children and adolescents. METHODS Data from 198 children and adolescents (median age 3 years, range 0-18 years) with dAKI from 2000 to 2006 was analysed for bleeding risks, haemorrhagic complications, underlying diseases, associated variables and mortality. One hundred and seven patients underwent peritoneal dialysis (PD), 71 continuous haemofiltration (CVVH) and 20 intermittent haemodialysis (HD) using systemic heparinization. RESULTS Fifty-three of 198 children (27%) suffered from one or more haemorrhagic complications; 63% of these complications were life-threatening. Bleeding was mainly diffuse (35 of 53). The incidence of haemorrhagic complications was significantly higher in patients on HD or CVVH compared to those on PD. Regression analysis of data showed that previous bleeding episodes or surgery, the underlying disease and the presence of multi-organ dysfunction syndrome (MODS) were strongly associated with haemorrhagic complications (P = 0.001). The overall mortality rate was 37%. Death was directly caused by bleeding complications (severe lung haemorrhage) in only three cases. Highly significant associated factors for mortality were the underlying disease, very young age, presence of MODS and acute haemorrhagic complications (P < 0.001). CONCLUSIONS We conclude that bleeding is a frequent and life-threatening complication in children with dAKI. Haemorrhagic complications seem to be a predictive, rather than a causative, factor for mortality.

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