• Sierra Hadley, Julie Thompson, Fernando Beltramo, John Marcum, and Karin Reuter-Rice.
• Sierra Hadley is an acute care pediatric nurse practitioner in the pediatric intensive care unit at Children's Hospital Los Angeles, California.
• Crit Care Nurse. 2024 Jun 1; 44 (3): 283528-35.

BackgroundThe mortality rate of pediatric patients who require continuous renal replacement therapy is approximately 42%, and outcomes vary considerably depending on underlying disease, illness severity, and time of dialysis initiation. Delay in the initiation of such therapy may increase mortality risk, prolong intensive care unit stay, and worsen clinical outcomes.Local ProblemIn the pediatric intensive care unit of an urban level I trauma children's hospital, continuous renal replacement therapy initiation times and factors associated with delays in therapy were unknown.MethodsThis quality improvement process involved a retrospective review of data on patients who received continuous dialysis in the pediatric intensive care unit from January 1, 2017, to December 31, 2021. The objectives were to examine the characteristics of the children requiring continuous renal replacement therapy, therapy initiation times, and factors associated with initiation delays that might affect unit length of stay and mortality.ResultsDuring the study period, 175 patients received continuous renal replacement therapy, with an average initiation time of 11.9 hours. Statistically significant associations were found between the degree of fluid overload and mortality (P < .001) and between the presence of acute kidney injury and prolonged length of stay (P = .04). No significant association was found between therapy initiation time and unit length of stay or mortality, although the average initiation time of survivors was 5.9 hours shorter than that of nonsurvivors.ConclusionFuture studies are needed to assess real time delays and to evaluate if the implementation of a standardized initiation process decreases initiation time.©2024 American Association of Critical-Care Nurses.

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