Abstract

Objective: The aim of this study was to evaluate the demographic and clinical characteristics, short-term outcomes, and early clinical and laboratory indicators associated with mortality in neonates receiving continuous renal replacement therapy (CRRT) in a tertiary neonatal intensive care unit.

Materials and Methods: This retrospective observational study included neonates younger than 28 days of postnatal age who received CRRT for at least 24 hours between October 1, 2019, and November 30, 2025. Patients were grouped according to in-hospital outcomes as survivors and non-survivors. Demographic, clinical, and laboratory variables were compared between the groups. Continuous variables with non-normal distributions were expressed as medians (IQR) and compared using the Mann–Whitney U test. Categorical variables were compared using the chi-square test or Fisher’s exact test, as appropriate. Given the limited sample size, the analyses were considered exploratory.

Results: A total of 13 neonates were included. The median gestational age was 38 weeks and the median birth weight was 2930 g. Nine patients (69.2%) died during hospitalization, whereas four (30.8%) were discharged. In the mortality group, the serum calcium level at 12 h was lower than that in survivors (8.50 [7.40–9.00] vs. 9.65 [9.13–10.4], p=0.044). Lactate levels were higher in the mortality group at both  hour 12 (4.00 [4.00–11.0] vs 2.95 [2.67–3.15], p=0.035) and hour 24 (4.40 [3.60–13.0] vs 2.40 [1.75–3.05], p=0.035). Baseline kidney function tests and most pre-CRRT biochemical parameters were similar between the groups.

Conclusion: In this single-center neonatal CRRT cohort, mortality was high. Lower total calcium at hour 12 and higher lactate levels at hours 12 and 24 were associated with mortality. These findings may reflect persistent physiological instability during the early phase of CRRT. However, because of the small sample size, retrospective design, and absence of multivariable adjustment, these associations should be interpreted as exploratory and hypothesis-generating rather than independent predictors of mortality.

References

  1. Guzzo I, de Galasso L, Bayazit AK, et al. Acute paediatric kidney replacement therapies in Europe: demographic results from the EurAKId Registry. Nephrol Dial Transplant. 2022;37:770-80. https://doi.org/10.1093/ndt/gfab280
  2. Cortina G, Daverio M, Demirkol D, Chanchlani R, Deep A. Continuous renal replacement therapy in neonates and children: what does the pediatrician need to know? An overview from the Critical Care Nephrology Section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). European Journal of Pediatrics. 2024;183:529-41. https://doi.org/10.1007/s00431-023-05318-0
  3. Rsovac S, Milosevic K, Spasojevic B, et al. Continuous Renal Replacement Therapy in Critically-Ill Term and Preterm Newborns: A Single-Center Study in Belgrade. Children (Basel). 2025;12(7):828. https://doi.org/10.3390/children12070828
  4. Slagle C, Askenazi D, Starr M. Recent Advances in Kidney Replacement Therapy in Infants: A Review. Am J Kidney Dis. 2024; 83:519-30. https://doi.org/10.1053/j.ajkd.2023.10.012
  5. Sebeih Y, Al-Turki A, Alfattani A, et al. Continuous kidney replacement therapy outcomes in infants and newborns. International Journal of Pediatrics and Adolescent Medicine, 2023;10(3):65–72. https://doi.org/10.4103/ijpam.ijpam_7_24
  6. Muff-Luett M, Webb T, Scobell R, et al. Dialysis modality and mortality of the Contemporary Infant and Neonatal Dialysis (COINED) Cohort: a Pediatric Nephrology Research Consortium (PNRC) study. Pediatric Nephrology. 2026;41:1731-42. https://doi.org/10.1007/s00467-025-07082-9
  7. Schaefer F, Straube E, Oh J, Mehls O, Mayatepek E. Dialysis in neonates with inborn errors of metabolism. Nephrology Dialysis Transplantation. 1999;14(4):910-8. https://doi.org/10.1093/ndt/14.4.910
  8. Starr MC, Charlton JR, Guillet R, et al. Advances in Neonatal Acute Kidney Injury. Pediatrics. 2021; 148 (5): e2021051220. https://doi.org/10.1542/peds.2021-051220
  9. Goldstein SL, Currier H, Graf JM, Cosio CC, Brewer ED, Sachdeva R. Outcome in Children Receiving Continuous Venovenous Hemofiltration. Pediatrics. 2001; 107(6):1309-12. https://doi.org/10.1542/peds.107.6.1309
  10. Kaymaz D, Bayhan SA, Kostekci YE, et al. Evaluation of anticoagulant methods in newborns undergoing continuous renal replacement therapy: what is the optimum method? Eur J Pediatr. 2025; 184:473. https://doi.org/10.1007/s00431-025-06314-2
  11. Alrashdi AS, Alshammari JN, Abdullah SK, et al. Outcomes of continuous kidney replacement therapy in pediatric patients: the impact of timing and predictors of mortality. Pediatr Nephrol. 2025; 40:2973-80. https://doi.org/10.1007/s00467-025-06794-2
  12. Slagle CL, Vuong KT, Krallman KA, et al. Infant Renal Replacement Therapy Using Carpediem: A Multicenter Observational Cohort Study from the ICONIIC Learning Network. J Pediatr. 2026; 288:114838. https://doi.org/10.1016/j.jpeds.2025.114838
  13. Noh ES, Kim HH, Kim HS, et al. Continuous Renal Replacement Therapy in Preterm Infants. Yonsei Med J. 2019; 60(10):984-91. https://doi.org/10.3349/ymj.2019.60.10.984
  14. Xu J, Chu X, Zhang W, et al. Analysis of risk factors for death in 59 cases of critically ill neonates receiving continuous renal replacement therapy: a two-centered retrospective study. Eur J Pediatr. 2023; 182:353-61. https://doi.org/10.1007/s00431-022-04693-4
  15. Deja A, Deja K, Cappoli A, et al. Predicting mortality and short-term outcomes of continuous kidney replacement therapies in neonates and infants. Nephrol Dial Transplant. 2026; 41:489-99. https://doi.org/10.1093/ndt/gfaf173
  16. Sun Y, Xu J, Chu X, et al. Effectiveness and feasibility of continuous renal replacement therapy for acute kidney injury in neonates weighing 3 kg or less: a two-centre, retrospective study. BMJ Paediatr Open. 2024; 8: e002241. https://doi.org/10.1136/bmjpo-2023-002241
  17. Menon S, Starr MC, Zang H, et al. Characteristics and outcomes of children ≤ 10 kg receiving continuous kidney replacement therapy: a WE-ROCK study. Pediatr Nephrol. 2025;40:253-64. https://doi.org/10.1007/s00467-024-06438-x
  18. Chu X, Xu J, Sun Y, Gong X, Chen D, Cai C. Continuous renal replacement therapy in neonates with multiple organ dysfunction syndrome: clinical utilization effects and outcomes. Italian Journal of Pediatrics. 2025; 51:275. https://doi.org/10.1186/s13052-025-02123-3
  19. Short K, Hanick J, Bickert P, Potts J, Askenazi D. Growth in neonates with congenital kidney failure requiring continuous kidney replacement therapy. Pediatr Nephrol. 2025;40:3733-41. https://doi.org/10.1007/s00467-025-06887-y
  20. Dolan KJ, Gist KM, Basalely A, et al. Functional outcomes in pediatric patients on renal replacement therapy in a worldwide registry. Nephrol Dial Transplant. 2025; 40(10):1919-30. https://doi.org/10.1093/ndt/gfaf067

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Copyright © 2026 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Önen Ocak B, Ertekin Ö, Öztürk S, Duranoğlu G, Yeke B, Balsak S, et al. Early clinical and laboratory findings associated with mortality during continuous renal replacement therapy in neonates. Turk J Pediatr Dis. 2026;Early View:1-6. https://doi.org/10.12956/TJPD.2026.1346