Multicenter Study

. 2025 Sep 29;40(10):1919-1930.

doi: 10.1093/ndt/gfaf067.

Functional outcomes in pediatric patients on renal replacement therapy in a worldwide registry

Kristin J Dolan¹, Katja M Gist², Abby Basalely³, Gabriella Bottari⁴, Abhishek Chakraborty⁵, Mihaela Damian⁶, Dana Fuhrman⁷, Denise C Hasson^{2

8}, Catherine Joseph¹, Dave Kwiatkowski⁹, Susan Martin¹⁰, Jenn Nhan¹¹, Nicolas Ollberding¹², David T Selewski¹³, Danielle Soranno¹⁴, Michelle C Starr¹⁴, Amy Strong¹⁵, Sameer Thadani¹, Huaiyu Zang¹², Ayse Akcan Arikan¹; WE-ROCK Collaborative

Collaborators, Affiliations

Collaborators

WE-ROCK Collaborative:
Emily Ahern, Ayse Akcan Arikan, Issa Alhamoud, Rashid Alobaidi, Pilar Anton-Martin, Shanthi S Balani, Matthew Barhight, Abby Basalely, Amee M Bigelow, Gabriella Bottari, Andrea Cappoli, Eileen A Ciccia, Michaela Collins, Denise Colosimo, Gerard Cortina, Mihaela A Damian, Sara De la Mata Navazo, Gabrielle DeAbreu, Akash Deep, Kathy L Ding, Kristin J Dolan, Sarah N Fernandez Lafever, Dana Y Fuhrman, Ben Gelbart, Katja M Gist, Stephen M Gorga, Francesco Guzzi, Isabella Guzzo, Taiki Haga, Elizabeth Harvey, Denise C Hasson, Taylor Hill-Horowitz, Haleigh Inthavong, Catherine Joseph, Ahmad Kaddourah, Aadil Kakajiwala, Aaron D Kessel, Sarah Korn, Kelli A Krallman, David M Kwiatkowski, Jasmine Lee, Laurance Lequier, Tina Madani Kia, Kenneth E Mah, Eleonora Marinari, Susan D Martin, Shina Menon, Tahagod H Mohamed, Catherine Morgan, Theresa A Mottes, Melissa A Muff-Luett, Siva Namachivayam, Tara M Neumayr, Jennifer Nhan, Abigail O'Rourke, Nicholas J Ollberding, Matthew G Pinto, Dua Qutob, Valeria Raggi, Stephanie Reynaud, Zaccaria Ricci, Zachary A Rumlow, María J Santiago Lozano, Emily See, David T Selewski, Carmela Serpe, Alyssa Serratore, Ananya Shah, Weiwen V Shih, H Stella Shin, Cara L Slagle, Sonia Solomon, Danielle E Soranno, Rachana Srivastava, Natalja L Stanski, Michelle C Starr, Erin K Stenson, Amy E Strong, Susan A Taylor, Sameer V Thadani, Amanda M Uber, Brynna Van Wyk, Tennille N Webb, Huaiyu Zang, Emily E Zangla, Michael Zappitelli

Affiliations

¹ Baylor College of Medicine, Texas Children's Hospital, Department of Pediatrics, Houston, TX, USA.
² University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Department of Pediatrics, Denver, CO, USA.
³ Zucker School of Medicine, Cohen Children's Medical Center, Department of Pediatrics, Hyde Park, NY, USA.
⁴ Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy.
⁵ University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Department of Cardiology, Memphis, TN, USA.
⁶ Emory University, Arthur M Blank Hospital Children's Healthcare, Department of Pediatrics, Atlanta, GA, USA.
⁷ University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Department of Pediatrics, Pittsburgh, PA, USA.
⁸ NYU Langone Health, Hassenfeld Children's Hospital, Department of Pediatrics, New York, NY, USA.
⁹ Stanford University School of Medicine, Lucile Packard Children's Hospital, Department of Pediatrics, Palo Alto, CA, USA.
¹⁰ University of Rochester Medical Center, Golisano Children's Hospital, Department of Pediatrics, Rochester, NY, USA.
¹¹ George Washington University School of Medicine, Children's National Hospital, Department of Pediatrics, Washington DC, USA.
¹² University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Cincinnati, OH, USA.
¹³ Medical University of South Carolina, MUSC Shawn Jenkins Children's Hospital, Department of Pediatrics, Charleston, SC, USA.
¹⁴ Indiana University School of Medicine, Riley Hospital for Children, Department of Pediatrics, Indianapolis, IN, USA.
¹⁵ Carver College of Medicine, University of Iowa Stead Family Children's Hospital, Department of Pediatrics, Iowa City, IA, USA.

PMID: 40258340
PMCID: PMC12709130 (available on 2026-04-21)
DOI: 10.1093/ndt/gfaf067

Multicenter Study

Functional outcomes in pediatric patients on renal replacement therapy in a worldwide registry

Kristin J Dolan et al. Nephrol Dial Transplant. 2025.

. 2025 Sep 29;40(10):1919-1930.

doi: 10.1093/ndt/gfaf067.

Authors

Collaborators

WE-ROCK Collaborative:
Emily Ahern, Ayse Akcan Arikan, Issa Alhamoud, Rashid Alobaidi, Pilar Anton-Martin, Shanthi S Balani, Matthew Barhight, Abby Basalely, Amee M Bigelow, Gabriella Bottari, Andrea Cappoli, Eileen A Ciccia, Michaela Collins, Denise Colosimo, Gerard Cortina, Mihaela A Damian, Sara De la Mata Navazo, Gabrielle DeAbreu, Akash Deep, Kathy L Ding, Kristin J Dolan, Sarah N Fernandez Lafever, Dana Y Fuhrman, Ben Gelbart, Katja M Gist, Stephen M Gorga, Francesco Guzzi, Isabella Guzzo, Taiki Haga, Elizabeth Harvey, Denise C Hasson, Taylor Hill-Horowitz, Haleigh Inthavong, Catherine Joseph, Ahmad Kaddourah, Aadil Kakajiwala, Aaron D Kessel, Sarah Korn, Kelli A Krallman, David M Kwiatkowski, Jasmine Lee, Laurance Lequier, Tina Madani Kia, Kenneth E Mah, Eleonora Marinari, Susan D Martin, Shina Menon, Tahagod H Mohamed, Catherine Morgan, Theresa A Mottes, Melissa A Muff-Luett, Siva Namachivayam, Tara M Neumayr, Jennifer Nhan, Abigail O'Rourke, Nicholas J Ollberding, Matthew G Pinto, Dua Qutob, Valeria Raggi, Stephanie Reynaud, Zaccaria Ricci, Zachary A Rumlow, María J Santiago Lozano, Emily See, David T Selewski, Carmela Serpe, Alyssa Serratore, Ananya Shah, Weiwen V Shih, H Stella Shin, Cara L Slagle, Sonia Solomon, Danielle E Soranno, Rachana Srivastava, Natalja L Stanski, Michelle C Starr, Erin K Stenson, Amy E Strong, Susan A Taylor, Sameer V Thadani, Amanda M Uber, Brynna Van Wyk, Tennille N Webb, Huaiyu Zang, Emily E Zangla, Michael Zappitelli

Affiliations

¹ Baylor College of Medicine, Texas Children's Hospital, Department of Pediatrics, Houston, TX, USA.
² University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Department of Pediatrics, Denver, CO, USA.
³ Zucker School of Medicine, Cohen Children's Medical Center, Department of Pediatrics, Hyde Park, NY, USA.
⁴ Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy.
⁵ University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Department of Cardiology, Memphis, TN, USA.
⁶ Emory University, Arthur M Blank Hospital Children's Healthcare, Department of Pediatrics, Atlanta, GA, USA.
⁷ University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Department of Pediatrics, Pittsburgh, PA, USA.
⁸ NYU Langone Health, Hassenfeld Children's Hospital, Department of Pediatrics, New York, NY, USA.
⁹ Stanford University School of Medicine, Lucile Packard Children's Hospital, Department of Pediatrics, Palo Alto, CA, USA.
¹⁰ University of Rochester Medical Center, Golisano Children's Hospital, Department of Pediatrics, Rochester, NY, USA.
¹¹ George Washington University School of Medicine, Children's National Hospital, Department of Pediatrics, Washington DC, USA.
¹² University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Cincinnati, OH, USA.
¹³ Medical University of South Carolina, MUSC Shawn Jenkins Children's Hospital, Department of Pediatrics, Charleston, SC, USA.
¹⁴ Indiana University School of Medicine, Riley Hospital for Children, Department of Pediatrics, Indianapolis, IN, USA.
¹⁵ Carver College of Medicine, University of Iowa Stead Family Children's Hospital, Department of Pediatrics, Iowa City, IA, USA.

PMID: 40258340
PMCID: PMC12709130 (available on 2026-04-21)
DOI: 10.1093/ndt/gfaf067

Abstract

Background and hypothesis: Mortality rates of children supported with continuous renal replacement therapy (CRRT) have improved, yet morbidity remains high. We aimed to evaluate the functional outcomes of children receiving CRRT using Functional Status Scale (FSS). We hypothesized that children receiving CRRT will have worse FSS compared with their baseline and acquire new morbidity at hospital discharge and 6 and 12 months post-discharge, and that lack of renal recovery will contribute to worsening functional status.

Methods: This is a retrospective chart review from The Worldwide Exploration of Renal Replacement Outcomes Collaborate in Kidney Disease (WE-ROCK), an international multi-center registry. Twenty-eight centers across five countries participated in this analysis. Children from birth to 25 years, on CRRT for acute kidney injury (AKI) or fluid overload, were included. Patients with underlying kidney disease, on extracorporeal membrane oxygenation and non-survivors were excluded. FSS was collected at discharge (n = 527), 6 months (n = 387) and 12 months post-discharge (n = 344). The primary outcome was FSS at discharge and 6 months. Secondary outcomes included: new morbidity at discharge and 6 months; FSS at 12 months; and the impact of renal recovery on functional outcomes.

Results: A total of 527 patients had median FSS of 7 (6, 90) at hospital discharge. Thirty-nine percent (n = 204) had worse FSS. Eighteen percent (95/527) acquired a new morbidity at discharge. Predictors of FSS at discharge were baseline FSS {odds ratio (OR) 1.30 [95% confidence interval (CI) 1.11-1.52]}, weight [OR 0.99 (95% CI 0.98-0.9997)], comorbidities [OR 1.88 (95% CI 1.16-3.04)], mechanical ventilation [OR 1.72 (95% CI 1.04-2.85)] and sepsis on intensive care unit admission [OR 1.46 (95% CI 1.01-2.21)]. A total of 387 patients had median FSS score of 6 (6, 8) at 6 months. Ten percent (n = 39/387) acquired new morbidity at 6 months. The significant predictors of FSS at 6 months were FSS at discharge [OR 2.36 (95% CI 1.95-2.84)] and presence of comorbidities [OR 1.77 (95% CI 1.03-3.06)].

Conclusion: This is the first large, multi-center study evaluating functional outcomes of children on CRRT. Persistent morbidity following discharge emphasizes the importance of comprehensive identification and multidisciplinary follow-up to optimize patient outcomes.

Keywords: AKI; dialysis; intensive care; pediatrics; quality of life.

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Conflict of interest statement

All authors report no real or perceived conflicts of interest that could affect the study design, collection, analysis and interpretation of data, the writing of the report, or the decision to submit the manuscript for publication. For full disclosure, we provide the additional list of authors’ other funding not directly related to this study. K.M.G. receives consultant fees from Bioporto Diagnostics and Potrero Medical, and receives funding from the Gerber foundation. D.F. receives funding from the National Institute of Diabetes and Digestive and Kidney Diseases (K23DK116973-05S1). M.C.S. receives funding from NIH (K23HL168362-01, R13DK137550-01) and Gerber Foundation. A.A.A.’s institution received research funding from Bioporto Diagnostics andMozarc Medical, she serves on the scientific advisory board of Seastar Medical. C.J. received a pilot grant award from Texas Children's Hospital for the year 2023–2024. D.T.S. receives funding from Bioporto Diagnostics as a speaker. D.S. internal grant for engineering in medicine Pilot Program and CTSI pilot award. D.K. is a consultant for Chiesi USA.

References

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Functional outcomes in pediatric patients on renal replacement therapy in a worldwide registry

Collaborators

Affiliations

Functional outcomes in pediatric patients on renal replacement therapy in a worldwide registry

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources