Early volume expansion during diarrhea and relative nephroprotection during subsequent hemolytic uremic syndrome

Christina A. Hickey, T. James Beattie, Jennifer Cowieson, Yosuke Miyashita, C. Frederic Strife, Juliana C. Frem, Johann M. Peterson, Lavjay Butani, Deborah P. Jones, Peter L. Havens, Hiren P. Patel, Craig S. Wong, Sharon Andreoli, Robert J. Rothbaum, Anne M. Beck, Phillip I. Tarr

Research output: Contribution to journalArticle

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Abstract

Objectives: To determine if interventions during the pre-hemolytic uremic syndrome (HUS) diarrhea phase are associated with maintenance of urine output during HUS. Design: Prospective observational cohort study. Settings: Eleven pediatric hospitals in the United States and Scotland. Participants: Children younger than 18 years with diarrhea-associatedHUS(hematocrit level≲λτ∀30%with smear evidence of intravascular erythrocyte destruction), thrombocytopenia (platelet count ≲λτ ∀150χ10 3/mm 3), and impaired renal function (serum creatinine concentration≲γτ∀upper limit of reference range for age). Interventions: Intravenous fluid was given within the first 4 days of the onset of diarrhea. Outcome Measure: Presence or absence of oligoanuria (urine output ≤0.5 mL/kg/h for >1 day). Results: The overall oligoanuric rate of the 50 participants was 68%, but was 84% among those who received no intravenous fluids in the first 4 days of illness. The relative risk of oligoanuria when fluids were not given in this interval was 1.6 (95% confidence interval, 1.1- 2.4; P=.02). Children with oligoanuric HUS were given less total intravenous fluid (r=-0.32; P=.02) and sodium (r=-0.27; P=.05) in the first 4 days of illness than those without oligoanuria. In multivariable analysis, the most significant covariate was volume infused, but volume and sodium strongly covaried. Conclusions: Intravenous volume expansion is an underused intervention that could decrease the frequency of oligoanuric renal failure in patients at risk of HUS.

Original languageEnglish
Pages (from-to)884-889
Number of pages6
JournalArchives of Pediatrics and Adolescent Medicine
Volume165
Issue number10
DOIs
StatePublished - Oct 2011

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Hemolytic-Uremic Syndrome
Diarrhea
Sick Leave
Sodium
Urine
Pediatric Hospitals
Scotland
Platelet Count
Hematocrit
Thrombocytopenia
Observational Studies
Renal Insufficiency
Creatinine
Reference Values
Cohort Studies
Erythrocytes
Maintenance
Outcome Assessment (Health Care)
Confidence Intervals
Kidney

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Early volume expansion during diarrhea and relative nephroprotection during subsequent hemolytic uremic syndrome. / Hickey, Christina A.; Beattie, T. James; Cowieson, Jennifer; Miyashita, Yosuke; Strife, C. Frederic; Frem, Juliana C.; Peterson, Johann M.; Butani, Lavjay; Jones, Deborah P.; Havens, Peter L.; Patel, Hiren P.; Wong, Craig S.; Andreoli, Sharon; Rothbaum, Robert J.; Beck, Anne M.; Tarr, Phillip I.

In: Archives of Pediatrics and Adolescent Medicine, Vol. 165, No. 10, 10.2011, p. 884-889.

Research output: Contribution to journalArticle

Hickey, CA, Beattie, TJ, Cowieson, J, Miyashita, Y, Strife, CF, Frem, JC, Peterson, JM, Butani, L, Jones, DP, Havens, PL, Patel, HP, Wong, CS, Andreoli, S, Rothbaum, RJ, Beck, AM & Tarr, PI 2011, 'Early volume expansion during diarrhea and relative nephroprotection during subsequent hemolytic uremic syndrome', Archives of Pediatrics and Adolescent Medicine, vol. 165, no. 10, pp. 884-889. https://doi.org/10.1001/archpediatrics.2011.152
Hickey, Christina A. ; Beattie, T. James ; Cowieson, Jennifer ; Miyashita, Yosuke ; Strife, C. Frederic ; Frem, Juliana C. ; Peterson, Johann M. ; Butani, Lavjay ; Jones, Deborah P. ; Havens, Peter L. ; Patel, Hiren P. ; Wong, Craig S. ; Andreoli, Sharon ; Rothbaum, Robert J. ; Beck, Anne M. ; Tarr, Phillip I. / Early volume expansion during diarrhea and relative nephroprotection during subsequent hemolytic uremic syndrome. In: Archives of Pediatrics and Adolescent Medicine. 2011 ; Vol. 165, No. 10. pp. 884-889.
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abstract = "Objectives: To determine if interventions during the pre-hemolytic uremic syndrome (HUS) diarrhea phase are associated with maintenance of urine output during HUS. Design: Prospective observational cohort study. Settings: Eleven pediatric hospitals in the United States and Scotland. Participants: Children younger than 18 years with diarrhea-associatedHUS(hematocrit level≲λτ∀30{\%}with smear evidence of intravascular erythrocyte destruction), thrombocytopenia (platelet count ≲λτ ∀150χ10 3/mm 3), and impaired renal function (serum creatinine concentration≲γτ∀upper limit of reference range for age). Interventions: Intravenous fluid was given within the first 4 days of the onset of diarrhea. Outcome Measure: Presence or absence of oligoanuria (urine output ≤0.5 mL/kg/h for >1 day). Results: The overall oligoanuric rate of the 50 participants was 68{\%}, but was 84{\%} among those who received no intravenous fluids in the first 4 days of illness. The relative risk of oligoanuria when fluids were not given in this interval was 1.6 (95{\%} confidence interval, 1.1- 2.4; P=.02). Children with oligoanuric HUS were given less total intravenous fluid (r=-0.32; P=.02) and sodium (r=-0.27; P=.05) in the first 4 days of illness than those without oligoanuria. In multivariable analysis, the most significant covariate was volume infused, but volume and sodium strongly covaried. Conclusions: Intravenous volume expansion is an underused intervention that could decrease the frequency of oligoanuric renal failure in patients at risk of HUS.",
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AU - Hickey, Christina A.

AU - Beattie, T. James

AU - Cowieson, Jennifer

AU - Miyashita, Yosuke

AU - Strife, C. Frederic

AU - Frem, Juliana C.

AU - Peterson, Johann M.

AU - Butani, Lavjay

AU - Jones, Deborah P.

AU - Havens, Peter L.

AU - Patel, Hiren P.

AU - Wong, Craig S.

AU - Andreoli, Sharon

AU - Rothbaum, Robert J.

AU - Beck, Anne M.

AU - Tarr, Phillip I.

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N2 - Objectives: To determine if interventions during the pre-hemolytic uremic syndrome (HUS) diarrhea phase are associated with maintenance of urine output during HUS. Design: Prospective observational cohort study. Settings: Eleven pediatric hospitals in the United States and Scotland. Participants: Children younger than 18 years with diarrhea-associatedHUS(hematocrit level≲λτ∀30%with smear evidence of intravascular erythrocyte destruction), thrombocytopenia (platelet count ≲λτ ∀150χ10 3/mm 3), and impaired renal function (serum creatinine concentration≲γτ∀upper limit of reference range for age). Interventions: Intravenous fluid was given within the first 4 days of the onset of diarrhea. Outcome Measure: Presence or absence of oligoanuria (urine output ≤0.5 mL/kg/h for >1 day). Results: The overall oligoanuric rate of the 50 participants was 68%, but was 84% among those who received no intravenous fluids in the first 4 days of illness. The relative risk of oligoanuria when fluids were not given in this interval was 1.6 (95% confidence interval, 1.1- 2.4; P=.02). Children with oligoanuric HUS were given less total intravenous fluid (r=-0.32; P=.02) and sodium (r=-0.27; P=.05) in the first 4 days of illness than those without oligoanuria. In multivariable analysis, the most significant covariate was volume infused, but volume and sodium strongly covaried. Conclusions: Intravenous volume expansion is an underused intervention that could decrease the frequency of oligoanuric renal failure in patients at risk of HUS.

AB - Objectives: To determine if interventions during the pre-hemolytic uremic syndrome (HUS) diarrhea phase are associated with maintenance of urine output during HUS. Design: Prospective observational cohort study. Settings: Eleven pediatric hospitals in the United States and Scotland. Participants: Children younger than 18 years with diarrhea-associatedHUS(hematocrit level≲λτ∀30%with smear evidence of intravascular erythrocyte destruction), thrombocytopenia (platelet count ≲λτ ∀150χ10 3/mm 3), and impaired renal function (serum creatinine concentration≲γτ∀upper limit of reference range for age). Interventions: Intravenous fluid was given within the first 4 days of the onset of diarrhea. Outcome Measure: Presence or absence of oligoanuria (urine output ≤0.5 mL/kg/h for >1 day). Results: The overall oligoanuric rate of the 50 participants was 68%, but was 84% among those who received no intravenous fluids in the first 4 days of illness. The relative risk of oligoanuria when fluids were not given in this interval was 1.6 (95% confidence interval, 1.1- 2.4; P=.02). Children with oligoanuric HUS were given less total intravenous fluid (r=-0.32; P=.02) and sodium (r=-0.27; P=.05) in the first 4 days of illness than those without oligoanuria. In multivariable analysis, the most significant covariate was volume infused, but volume and sodium strongly covaried. Conclusions: Intravenous volume expansion is an underused intervention that could decrease the frequency of oligoanuric renal failure in patients at risk of HUS.

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