Year: 2026 | Month: September | Volume: 16 | Issue: 9 | Pages: 240-246
DOI: https://doi.org/10.52403/ijhsr.20260924
Spectrum of Clinical Diseases Requiring Acute Hemodialysis and Its Outcomes Among Children in Pediatric Intensive Care Unit in a Tertiary Care Center
Ajay R1, M.S. Abilash2, Venisha M3, Sahasyaa Adalarasan3
1Junior Resident, 2Assistant Professor, 3Medical Student,
Institute of Child Health and Hospital for Children, Madras Medical College, Egmore, Chennai, Tamil Nadu, India.
Corresponding Author: Sahasyaa Adalarasan
ABSTRACT
Background: Acute kidney injury (AKI) is an important complication among critically ill children and may necessitate acute hemodialysis when severe renal dysfunction or associated metabolic complications develop. However, the spectrum of clinical conditions requiring hemodialysis and factors associated with outcomes in critically ill children remain insufficiently characterized. This study evaluated the clinical indications, outcomes, and factors associated with mortality among children requiring acute hemodialysis in a pediatric intensive care unit (PICU).
Methods: This prospective observational study included children aged 1 month to 12 years who underwent acute hemodialysis in the PICU of a tertiary care center. Demographic characteristics, underlying clinical conditions, indications for dialysis, duration of dialysis, urea clearance, complications, and clinical outcomes were recorded. Continuous variables were summarized using descriptive statistics, while categorical variables were expressed as frequencies and percentages. Binary logistic regression was used to assess factors associated with mortality, and the association between urea clearance categories and outcome was evaluated using the chi-square test. A p value <0.05 was considered statistically significant.
Results: Fifty-four children requiring acute hemodialysis were included. AKI was the most frequent indication for dialysis (34/54, 63.0%), followed by uremic manifestations (13/54, 24.1%), metabolic acidosis (8/54, 14.8%), and hyperkalemia (8/54, 14.8%). Overall, 24 children (44.4%) died, while 30 (55.6%) survived. Mortality was particularly high among children with hyperammonemia and metabolic acidosis. Metabolic acidosis was associated with increased odds of mortality, although the association did not reach statistical significance (OR, 7.88; 95% CI, 0.87–71.13; p=0.066). Urea clearance category was significantly associated with outcome (p=0.0099), with higher mortality observed in children with lower urea clearance.
Conclusion: Acute hemodialysis was required for a broad spectrum of clinical conditions in critically ill children, with AKI being the predominant indication. Mortality remained substantial, particularly among children with severe metabolic complications. Urea clearance was significantly associated with outcome and may provide useful prognostic information in children undergoing acute hemodialysis.
Key words: Acute hemodialysis, Acute kidney injury, Pediatric intensive care unit, Hemodialysis outcomes, Pediatric renal replacement therapy, Mortality, Urea clearance, Dialysis indications