Complications and outcomes of children under one year treated with continuous renal replacement therapy.

Background Continuous renal replacement therapy (CRRT) in children under 12 months of age is challenging. This study aimed to compare complications and mortality between patients younger and older than 12 months receiving CRRT and to identify independent mortality risk factors. Methods Retrospective observational study of pediatric patients treated with CRRT using adult devices in a tertiary hospital (2010–2023). Demographic, clinical, and laboratory data, as well as complications, were analyzed. Independent predictors of mortality were identified using multivariate logistic regression. Results A total of 186 patients were analyzed; 69% had heart disease as the main diagnosis. Common complications were catheter replacement (29%), hypotension during connection (28%), bleeding (27%), and hypocalcemia (27%). Overall mortality was 31%. Compared with older children (n = 105), infants under 12 months (n = 81) had more catheter replacements (37% vs. 23%, p = 0.02), hypomagnesemia (23% vs. 10%, p = 0.008), and hypothermia (32% vs. 15%, p = 0.005), but less hypocalcemia (19% vs. 33%, p = 0.017). Mortality was higher among infants (41% vs. 23%, p = 0.007). In multivariate analysis, bleeding (OR 3.16, 95% CI 1.49–6.75, p = 0.003), initial lactate > 3 mmol/L (OR 2.99, 95% CI 1.32–6.87, p = 0.009), and normal initial creatinine (OR 3.20, 95% CI 1.35–7.78, p = 0.009) were independently associated with mortality. Conclusions Children under 12 months compared to older children had similar frequency of complications except for higher rates of catheter replacement, hypomagnesemia, hypothermia and mortality. Independent mortality predictors were bleeding, initial lactate > 3 mmol/L and normal initial creatinine levels.