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Observational Study
. 2025 Sep;40(9):2957-2966.
doi: 10.1007/s00467-025-06777-3. Epub 2025 Apr 24.

Hyperglycemia and kidney outcomes in critically ill children and young adults on continuous kidney replacement therapy

Shrea Goswami  1 , Katja M Gist  2 , Petter Bjornstad  3 , Eileen Ciccia  4 , Akash Deep  5 , Ben Gelbart  6 , Shina Menon  7 , Eleonora Marinari  8 , Nicholas J Ollberding  2 , Dua Qutob  9 , JangDong Seo  2 , Danielle E Soranno  1   10 , Brynna Van Wyk  11 , Michelle C Starr  12   13 ; Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) Collaborative
Collaborators, Affiliations
Observational Study

Hyperglycemia and kidney outcomes in critically ill children and young adults on continuous kidney replacement therapy

Shrea Goswami et al. Pediatr Nephrol. 2025 Sep.

Abstract

Background: There are limited studies evaluating hyperglycemia in children treated with continuous kidney replacement therapy (CKRT). We evaluated the association of hyperglycemia with kidney outcomes in critically ill children treated with CKRT for acute kidney injury (AKI) or fluid overload.

Methods: Secondary analysis of the multicenter retrospective observational Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) study (34 centers, 9 countries). Primary exposure was hyperglycemia on days 0-7 of CKRT (average serum glucose of ≥ 150 mg/dL). Average serum glucose < 150 mg/dL was defined as euglycemic. We stratified the hyperglycemic group with cut-offs ≥ 180 mg/dL, ≥ 200 mg/dL, or ≥ 250 mg/dL. The primary outcome was MAKE-90 (death by 90 days or persistent kidney dysfunction [> 125% baseline serum creatinine, or dialysis dependence]).

Results: Of 985 participants, 48% (473) had average serum glucose > 150 mg/dL during days 0-7 of CKRT. There were higher rates of death in the hyperglycemic group (44% vs. 32%, p < 0.001) and longer length of stay among survivors (42 vs. 38 days, p = 0.017) compared to the euglycemic group. Those with average glucose ≥ 150 mg/dL had higher unadjusted odds of MAKE-90 (OR: 1.36, 95% CI 1.02-1.81); this finding did not remain after multivariate adjustment. Those with average glucose ≥ 180 mg/dL had higher adjusted odds of MAKE-90 (aOR: 1.44, 95% CI 1.02-2.04). In adjusted analysis, each 10 mg/dL increase in glucose was associated with 3% increased odds of MAKE-90.

Conclusions: Hyperglycemia is associated with worse kidney outcomes among young persons on CKRT for AKI or fluid overload. Further studies are needed to evaluate the causality and determine appropriate glucose ranges in this high-risk population.

Keywords: Acute kidney injury; Citrate; Continuous kidney replacement therapy; Dialysis; Glucose; WE-ROCK.

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Conflict of interest statement

Declarations. All authors declare no real or perceived conflicts of interest that could affect the study design, collection, analysis, or 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 commitments and funding sources that are not directly related to this study: Katja M. Gist is a consultant for Bioporto Diagnostics and Potrero Medical and receives funding from the Gerber Foundation. Shina Menon is a consultant for Medtronic, Inc and Nuwellis, Inc and receives funding from the Gerber Foundation. Michelle C. Starr receives funding from the National Institutes of Health (NIDDK and NHLBI). Petter Bjornstad reports serving or having served as a consultant for AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Eli Lilly, LG Chemistry, Sanofi, Novo Nordisk, and Horizon Pharma. P.B. also serves or has served on the advisory boards and/or steering committees of AstraZeneca, Bayer, Boehringer Ingelheim, Novo Nordisk, and XORTX. P.B. receives funding from National Institute of Health (NIDDK, NIEHS, NHLBI), Breakthrough T1D (formerly JDRF), American Heart Association and American Diabetes Association. Danielle E. Soranno receives funding from the Engineering in Medicine Program at Indiana University and Purdue University. Nicholas J. Ollberding provides statistical consulting services to SeaStar Medical Inc. No other disclosures were reported. Data cleaning and management supported in kind by the CCHMC Heart Institute Research Core. Statistical analyses supported by internal CCHMC funding (PI Gist).

Figures

None
A higher resolution version of the Graphical abstract is available as Supplementary information
Fig. 1
Fig. 1
Hyperglycemia and adjusted odds ratio with MAKE- 90 outcomes
See this image and copyright information in PMC

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