54 Timing the initiation of renal replacement therapy (RRT) in critically ill children
Bibliographic record
Abstract
Clinical Question In infants and children admitted to the paediatric intensive care unit requiring RRT, does early initiation of RRT (within 48 hours of stage III Acute Kidney Injury (AKI)) vs late initiation of RRT (over 48 hours from stage III AKI) lead to a decrease in mortality from ICU? Purpose Severe AKI increases mortality in critically ill children and infants, with variations in treatment strategies from conservatively managing volume status and biochemical abnormalities, to the escalated and invasive nature of RRT. There are few studies exploring the optimal timing of RRT. Methods The following databases were searched: PubMed, Cochrane Library and Emboss, using specific search terms. 7 articles met the inclusion criteria and were reviewed. Results and Conclusions When the timing of RRT initiation is defined as from ICU admission, early initiation is associated with lower mortality but this should be treated with caution, as there is an assumption all patients require RRT from the time of ICU admission (figure 1). When the time to initiation of RRT is defined as from when RRT was indicated (for example severe AKI refractory to medical management), observational data shows the longer time is associated with higher mortality. However there is conflicting data in randomised controlled trials in adults. Limitations The current, mainly retrospective data, in a heterogenous paediatric population, is prone to bias and confounding given that the decision to start RRT is complex and multifactorial. Implications Determining the optimal strategy and timing of initiation of RRT is vital in improving clinical outcomes. Future prospective studies differentiating which children require RRT from those that can be managed supportively would allow fairer comparison of outcomes between ‘early’ versus ‘late’ initiation, as the need for RRT may be averted in a ‘delayed’ strategy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.030 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".