Children’s of Alabama is part of international research effort designed to improve care for CRRT patients.
With most research that evaluates a vital form of dialysis care in children called continuous renal replacement therapy (CRRT) lacking in size and scope—hampering efforts to glean practice-changing insights—an international effort in which Children’s of Alabama is integral is expected to fill the gap.
Dubbed WE ROCK (Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease), the retrospective study involves a total of nearly 1,000 children treated at 32 centers in seven countries between 2018 and 2021. Representing the largest international registry of children receiving CRRT for acute kidney injury or fluid overload—which can result from a variety of factors, including congenital anomalies, nephrotoxins and others—WE ROCK aims to evaluate the association of factors such as fluid balance and timing of CRRT initiation and duration with patient outcomes.
“It’s so hard to get data of this type, so this study is very significant,” said Children’s of Alabama pediatric nephrologist Tennille Webb, M.D., who’s also assistant director of the Pediatric and Infant Center for Acute Nephrology (PICAN) and an assistant professor of nephrology and pediatrics at University of Alabama at Birmingham (UAB). At Children’s, research nurse coordinator Jessica Potts, RN, is carrying out the crucial task of collecting and analyzing the data.
Children’s serves as a hub for CRRT care for a high volume of pediatric kidney patients. In the decade-plus between 2013 and mid-2024, 602 patients were treated with CRRT at Children’s. Just over half of CRRT is performed in the neonatal intensive care unit (NICU), while 32% is done in the pediatric intensive care unit (PICU) and the remaining 15% in the cardiovascular intensive care unit (CVICU).
Children’s has long stood out among pediatric hospitals by offering CRRT to the tiniest infants using modified Aquadex equipment. Aquadex had initially been developed for adult patients with heart failure to remove fluid from the heart, but Children’s nephrologist and PICAN director David Askenazi, M.D., seized on the technology’s small filters to adapt it for use in neonates. Now, other centers offer neonatal dialysis with modified Aquadex, as well.
“Other dialysis machines pull a lot of blood out of babies because the filters are so large, which makes everyone nervous,” Webb explained. “CRRT is gentler than hemodialysis because you can remove fluid at a slower rate over an extended amount of time, allowing for fewer fluid shifts and blood pressure swings, especially in those who may have low blood pressure. We’re still meeting our goals, but not being as aggressive.”
The WE ROCK effort has generated at least 10 published manuscripts so far by study collaborators, with the promise of many more to come, Webb says. By looking at outcomes such as major adverse kidney events 90 days after CRRT (including mortality, dialysis dependence, and persistent kidney dysfunction) as well as functional outcomes, investigators should be able to derive data that could change pediatric nephrology practice.
Insights will be bidirectional: Children’s specialists will learn from other centers, and others will learn from Children’s. Researchers can also determine new questions and angles that fuel future research. It’s an exciting prospect for Webb and her colleagues.
“Having that data from 32 centers, we can see what they’re doing, model it and make some improvements in these patients,” Webb said.
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