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. 2025;54(6):322-333.
doi: 10.1159/000545777. Epub 2025 Apr 11.

Thrombocytopenia in Children and Young Adults Undergoing Continuous Renal Replacement Therapy: A WE-ROCK Study

Abby Basalely  1 , Katja M Gist  2 , Natalja L Stanski  2 , Dana Y Fuhrman  3 , JangDong Seo  4 , Nicholas J Ollberding  4 , Amy Strong  5 , Mihaela Damian  6 , Catherine Morgan  6 , Stephanie Reynaud  7 , Melissa Muff-Luett  7 , Akash Deep  8 , Carmela Serpe  9 , Kelli A Krallman  2 , Shina Menon  10 ; WE-ROCK Investigators
Affiliations

Thrombocytopenia in Children and Young Adults Undergoing Continuous Renal Replacement Therapy: A WE-ROCK Study

Abby Basalely et al. Blood Purif. 2025.

Abstract

Introduction: Thrombocytopenia in patients treated with continuous renal replacement therapy (CRRT) in adults is associated with mortality. Pediatric data are limited. The association between pre-CRRT thrombocytopenia and platelet decline at 24 h of CRRT with outcomes was evaluated.

Methods: Secondary analysis of the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) includes patients' birth-25 years who underwent CRRT. Exclusions were end-stage kidney disease, non-acute kidney injury/fluid overload CRRT indication, concurrent extracorporeal membrane oxygenation, missing baseline platelets, platelet disorders, and hematologic malignancy. Primary exposures were (i) pre-CRRT thrombocytopenia (≤100 × 103/μL) and (ii) ≥30% decline at 24 h of CRRT in those with pre-CRRT >100 × 103/μL. Primary outcome was survival to intensive care unit (ICU) discharge. Secondary outcomes included major adverse kidney events at 90 days (MAKE-90) (death, dialysis dependence, creatinine >125% baseline) from CRRT initiation.

Results: A total of 805 patients were included. Overall, 63.9% had baseline thrombocytopenia, median (IQR) platelets of 38 (20, 63) ×103/μL. Baseline thrombocytopenia occurred in younger septic patients with higher illness severity. A ≥30% decline occurred in 33% of patients. Those with a ≥30% platelet decline were more commonly younger patients and had smaller catheters. Pre-CRRT thrombocytopenia and platelet decline were associated with ICU mortality in univariate but not multivariate models. There was no association with MAKE-90.

Conclusions: Thrombocytopenia is common prior to CRRT initiation and is associated with greater illness severity. These findings stress the importance of vigilant monitoring of platelet levels before CRRT initiation and during therapy as thrombocytopenia at both time points may be a prognostic indicator. Additionally, this study highlights the need for future research to clarify the interplay of patient and mechanical factors in this phenomenon and guide potential interventions.

Keywords: Acute kidney injury; Continuous renal replacement therapy; Critically ill children; MAKE-90; Thrombocytopenia.

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Conflict of interest statement

All authors declare no real or perceived conflicts of interest that could affect the study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit for publication. For full disclosure, we provide here an additional list of other author’s commitments and funding sources that are not directly related to this study: Katja M. Gist is a consultant for BioPorto Diagnostics and Potrero Medical. Shina Menon is a consultant for Medtronic, Inc., and Nuwellis, Inc. Theresa A. Mottes is a consultant for Medtronic, Inc. Melissa Muff-Luett is a consultant for Medtronic, Inc. No other competing interests were reported. Akash Deep was a member of the journal’s Editorial Board at the time of submission.

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