Outcomes of Prolonged Intermittent Renal Replacement Therapy Combined with Hemoperfusion among Patients Aged <18 Years Old with Severe Dengue

Abstract

Context: Fluid overload is inevitable in severe dengue shock syndrome despite intensive fluid management. Aims: To compare the outcomes of prolonged intermittent renal replacement therapy (PIRRT) with or without hemoperfusion (HP) in treating severe dengue among patients ≤18 years old. Settings and Design: Retrospective cohort study in the hemodialysis unit of a tertiary hospital in the Philippines. Methods: Demographic and clinical data, kidney replacement therapy prescription variables, hemodynamic status, and outcomes were analyzed retrospectively for pediatric patients who underwent PIRRT with or without HP for severe dengue. The primary outcome was 28-day all-cause mortality, whereas secondary outcomes were changes in percent fluid overload, vasopressor index (VI), mean arterial pressure, and vasopressor dependency. Statistical Analysis Used: Mann–Whitney U, Chi-square, Fisher exact, and Student’s t test. Results: Among 357 severe dengue patients, 27 underwent PIRRT with (n = 18) or without (n = 9) HP. Baseline demographic and clinical characteristics differed significantly only with respect to the degree of fluid overload, time to therapy initiation, proportion with obesity and overweight, and duration of treatment during the first session. There were no significant differences between the two groups in 28-day mortality (PIRRT, n = 7 of 9, vs. PIRRT + HP, n = 10; P = 0.40) or secondary outcomes except an increased VI in PIRRT group (mean 38.2 vs. 12.4; P = 0.04). Conclusions: PIRRT combined with HP is feasible in hemodynamically unstable children with severe dengue in a resource-limited setting, but the outcomes of the combination are similar to those with PIRRT alone. Larger prospective studies should examine the efficacy of the combination of PIRRT with HP in terms of the dialysis dose and changes in cytokine levels or other inflammatory markers.