241: Renal Replacement Therapy in Critically Ill Children on Extracorporeal Membrane Oxygenation: A Retrospective Single Center Study
Bibliographic record
Abstract
Background: The optimal timing and modality for initiating renal replacement therapy (RRT) on extracorporeal membrane oxygenation (ECMO) remains unclear. This study describes the clinical characteristics and outcomes of children who received RRT while on ECMO. Methods: A retrospective cohort analysis was conducted on patients <25 years who received RRT while on ECMO at Boston Children’s Hospital from January, 2014 to June, 2024. Patients who received RRT prior to ECMO were excluded. Descriptive statistics are reported. Results: Fifty-six patients received RRT on ECMO; 24/56(43%) were female, with median age 6-months (IQR: 0-75 months) and weight 6.4kg (IQR:3.45-16.7kg). Among patients, 15/56(27%) were medical, 17/56(30%) were surgical, and 24(43%) were cardiac. All received slow continuous ultrafiltration (SCUF) and were initially treated with intermittent hemodialysis (iHD). The median percent fluid overload at the time of iHD initiation was 19% (IQR: 5-41%). Only 7/56(13%) patients received alternate forms of RRT after iHD; 3/7(43%) received continuous renal replacement therapy and 4/7(57%) received peritoneal dialysis. RRT was started at a median of 9 days(IQR: 5-13 days) after ECMO cannulation, most commonly for uremia (42/56, 75%). Median RRT duration was 10 days (IQR: 5-21 days), median ECMO duration was 19 days (IQR: 11-30 days). Survival was 21%(12/56) with no RRT-dependence at discharge. Conclusions: ECMO patients were fluid overloaded at RRT initiation despite receiving SCUF. Future analyses should focus on the timing and modality of RRT in ECMO patients to improve outcomes.
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".