An epidemiological assessment of hemodialysis, continuous kidney replacement therapy, and peritoneal dialysis in pediatric acute kidney injury patients.

Authors

Sanat Subhash, Ethan Kalina, Jacob Almeda, Arwa Nada, Aadil Kakajiwala, Rupesh Raina

Published in

Renal failure. Volume 48. Issue 1. Pages 2706951. Epub Aug 10, 2026.

Abstract

Hemodialysis (HD), peritoneal dialysis (PD), and continuous kidney replacement therapy (CKRT) are major modalities of kidney replacement therapy (KRT) in pediatric acute kidney injury (AKI). This study uses TriNetX data to identify clinical characteristics of pediatric AKI patients receiving HD, PD, and CKRT and compare outcomes across 30-, 90-, 180-, and 365-day follow-ups.
Pediatric patients aged 0-18 years with AKI (August 2004-August 2024) were identified using ICD-10 and CPT codes within the TriNetX U.S. Network. Three cohorts (HD, PD, CKRT) were analyzed for outcomes and comorbidities. Kidney transplant recipients were excluded. Cohorts were not propensity matched to reflect real-world disease burden. A total of 7,476 pediatric patients (mean age ∼9 years) initiated KRT [HD 39.1% (n = 2,929), PD 41.9% (n = 3,139), CKRT 18.8% (n = 1,408)].
CKRT patients had higher BUN (19.7 mg/dL) and glucose (136 mg/dL). Intestinal diseases were frequent comorbidities. Hypertension was most common in CKRT (12.1%). Diuretics (12.1%) and epinephrine (11.3%) were the most used medications. At 30 days, mortality was lowest in HD (13.7%) vs PD (14.9%) and CKRT (19.9%). This persisted at 365 days (CKRT 24.2%). Ventilation rates were 22.0% (HD), 23.1% (PD), 25.6% (CKRT). ICU admission was highest in CKRT (71.1%).
CKRT had the greatest ten-year incidence (3.6%) and prevalence (3.8%). HD and PD had lower observed mortality and ICU admission than CKRT, a pattern likely reflecting confounding by indication rather than a causal effect of modality. CKRT patients showed higher comorbidity burden and mortality, emphasizing the need for individualized management in pediatric AKI.

PMID:
42572520
Bibliographic data and abstract were imported from PubMed on 10 Aug 2026.

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