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Non-Receipt of Fluids in Children Tied to Increased Oligoanuria

Increased risk for children who do not receive fluids in pre-hemolytic uremic syndrome diarrhea phase

MONDAY, July 25 (HealthDay News) -- Young patients with pre-hemolytic uremic syndrome (HUS) diarrhea, who do not receive intravenous fluids within the first four days of diarrhea onset, have increased risk of developing oligoanuria, according to a study published online July 22 in the Archives of Pediatrics & Adolescent Medicine.

Christina A. Hickey, M.D., from the Washington University School of Medicine in St. Louis, and colleagues investigated whether interventions during the pre-HUS diarrhea phase are correlated with maintenance of urine output during HUS. A total of 50 children aged younger than 18 years with diarrhea-associated HUS (hematocrit level <30 percent), thrombocytopenia (platelet count <150 × 10³/mm³, and impaired renal function (serum creatinine concentration greater than upper limit of reference range for age) were included in the study. Intravenous fluid was given within the first four days of diarrhea onset. The primary outcome measure was the presence or absence of oligoanuria (urine output ≤0.5 mL/kg/h for more than one day).

The investigators found that the oligoanuric rate was 68 percent overall, and was 84 percent among participants who did not receive intravenous fluids in the first four days of diarrhea. The relative risk for oligoanuria was significantly higher when fluids were not given during the first four days (1.6). Compared to children without oligoanuria, those with oligoanuric HUS received significantly less fluid and sodium in the first four days of illness. After adjusting for confounding variables, the volume infused was found to be the most significant covariate, whereas volume and sodium strongly covaried.

"Intravenous volume expansion is an underused intervention that could decrease the frequency of oligoanuric renal failure in patients at risk of HUS," the authors write.

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