A Hierarchical Endpoint Analysis of the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) Cohort.

Authors

Dana Y Fuhrman, Katja M Gist, Ayse Akcan Arikan, Sean M Bagshaw, Andrew D Shaw, Matthieu Legrand, D'Arcy Duquette, Shina Menon, Nicholas J Ollberding, Indrani Sarkar, Zaccaria Ricci, Rashid Alobaidi, Emily See, Danielle E Soranno, David T Selewski, Aadil Kakajiwala, Stuart L Goldstein, WE-ROCK Investigators

Published in

Clinical journal of the American Society of Nephrology : CJASN. Jul 10, 2026. Epub Jul 10, 2026.

Abstract

Data to guide assessment of readiness for liberation from continuous renal replacement therapy (CRRT) in children are limited, and hierarchical composite endpoints have not been applied in this setting. We evaluated whether performing a trial of CRRT liberation among patients with preserved urine output is associated with improved outcomes using a hierarchical endpoint approach.
We conducted a retrospective cohort study of patients aged ≤25 years from the multicenter Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) registry. Patients with urine output >0.5 mL/kg/hour for ≥24 hours within the first five days after CRRT initiation were included. The primary exposure was a trial of CRRT liberation by day 5. The primary outcome was a hierarchical composite of: (1) 90-day mortality, (2) 90-day kidney replacement therapy dependence, (3) intensive care unit (ICU)-free days, and (4) hospital-free days. Inverse probability weighting was used to balance baseline characteristics, and outcomes were compared using a win ratio analysis.
Among 366 eligible patients, 192 (53%) underwent a liberation trial by day 5. These patients were older, had higher reference serum creatinine levels, and exhibited lower illness severity when compared to those who did not undergo a trial of liberation. In adjusted analyses, a liberation trial was associated with an improved hierarchical outcome (win ratio, 2.14 [95% confidence interval [CI], 1.56-2.94], p <0.001), driven primarily by greater ICU- and hospital-free days.
Among CRRT recipients with preserved urine output, a trial of liberation by day 5 was associated with improved outcomes, supporting the early assessment of liberation readiness in patients with a urine output >0.5 mL/kg/hour.

PMID:
42455640
Bibliographic data and abstract were imported from PubMed on 15 Jul 2026.

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