This retrospective epidemiological assessment used the TriNetX U.S. Network to identify pediatric patients (age 0–18 years) diagnosed with acute kidney injury (AKI) who initiated kidney replacement therapy (KRT) between August 2004 and August 2024. A total of 7,476 children were included. Kidney transplant recipients were explicitly excluded. The cohort's mean age was approximately 9 years.
Cases were identified using ICD-10 and CPT codes within the TriNetX database. The analysis created three non–propensity-matched cohorts according to the initial KRT modality: hemodialysis (HD), peritoneal dialysis (PD), and continuous kidney replacement therapy (CKRT). The authors elected not to perform propensity matching in order to reflect real-world disease burden across modalities. Outcomes were assessed across multiple follow-up intervals at 30, 90, 180, and 365 days.
Of the 7,476 pediatric patients who initiated KRT, 39.1% (n = 2,929) received HD, 41.9% (n = 3,139) received PD, and 18.8% (n = 1,408) received CKRT. Mean age across the overall sample was about 9 years. The abstract reports selected laboratory values and physiologic measures: CKRT patients had higher blood urea nitrogen (BUN) (reported mean 19.7 mg/dL) and higher serum glucose (reported mean 136 mg/dL) relative to the other modality cohorts.
Comorbid conditions were prevalent across cohorts; intestinal diseases were noted as frequent comorbidities in the population. Hypertension was most commonly observed among CKRT recipients (12.1%). Medication exposure recorded in the dataset included diuretics (12.1% overall) and epinephrine (11.3% overall). The CKRT cohort demonstrated a higher overall comorbidity burden in the dataset reported.
Mortality differed across modalities at the time points reported. At 30 days, observed mortality was lowest in the HD group (13.7%), followed by PD (14.9%), and highest in the CKRT group (19.9%). This pattern persisted through 365 days, where CKRT patients had the highest reported mortality (24.2%). The authors interpret these differences as likely influenced by baseline illness severity rather than a direct causal effect of modality selection.
Intensive care utilization metrics were higher in the CKRT cohort. ICU admission was most frequent among CKRT patients (71.1%). Reported rates of mechanical ventilation were 22.0% for HD, 23.1% for PD, and 25.6% for CKRT. These findings align with the higher comorbidity and severity indicators reported in the CKRT group.
Across the ten-year period evaluated in the study, CKRT had the greatest reported ten-year incidence (3.6%) and prevalence (3.8%) among the three modalities. The abstract does not provide additional stratified incidence or prevalence data beyond these summary figures.
The authors emphasize that observed higher mortality and greater ICU admission with CKRT are likely reflective of confounding by indication—that is, sicker children with greater physiologic derangement are more likely to receive CKRT. CKRT patients in the dataset showed higher markers of illness severity (higher BUN and glucose), more comorbid conditions, and greater need for ICU resources, which helps explain the modality-associated outcome differences reported.
Clinically, these findings underscore the importance of individualized management strategies for pediatric AKI and cautious interpretation when comparing outcomes across KRT modalities. The decision to use HD, PD, or CKRT in children with AKI should remain guided by patient age, hemodynamic stability, comorbidities, available resources, and the underlying clinical context—factors that also influence observed outcomes in registry and administrative datasets.
The abstract reports that cohorts were not propensity matched to preserve the real-world disease burden; beyond that, specific limitations such as potential coding errors, missing data, adjustments for illness severity scores, or center-level practice variation were not detailed in the abstract. If more granular limitations or adjusted analyses were performed, those details were not reported in the source abstract.
In this TriNetX analysis of 7,476 pediatric AKI patients who initiated KRT, HD and PD were more commonly used than CKRT, but CKRT recipients had higher comorbidity burden, greater ICU use, higher short- and long-term mortality, and higher ten-year incidence and prevalence measures. The authors caution that modality-associated outcome differences likely reflect underlying patient severity and confounding by indication rather than intrinsic advantages or harms of any single dialysis modality.