Shina Menon

All Publications

• Continuous Kidney Replacement Therapy and Survival in Children and Young Adults: Findings From the Multi-National WE-ROCK Collaborative. American journal of kidney diseases : the official journal of the National Kidney Foundation Starr, M. C., Gist, K. M., Zang, H., Ollberding, N. J., Balani, S., Cappoli, A., Ciccia, E., Joseph, C., Kakajiwala, A., Kessel, A., Muff-Luett, M., Santiago Lozano, M. J., Pinto, M., Reynaud, S., Solomon, S., Slagle, C., Srivastava, R., Shih, W. V., Webb, T., Menon, S. 2024

  Abstract

  There are limited studies describing the epidemiology and outcomes of children and young adults receiving continuous kidney replacement therapy (CKRT). We aimed to describe associations between patient characteristics, CKRT prescription, and survival.Retrospective multicenter cohort study.& Participants: 980 patients aged birth-25 years old who received CKRT between 2015 and 2021 at 1 of 32 centers in 7 countries participating in the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Diseases (WE-ROCK).CKRT for acute kidney injury or volume overload.Death before ICU discharge.Descriptive statistics.Median age was 8.8 years (IQR 1.6, 15.0) with a median weight of 26.8 kg (IQR 11.6, 55.0). CKRT was initiated a median of 2 days (IQR 1, 6) after ICU admission and lasted a median of 6 days (IQR 3, 14). The most common CKRT modality was continuous veno-venous hemodiafiltration. Citrate anticoagulation was used in 62%, and the internal jugular vein was the most common catheter placement location (66%). 629 participants (64.1%) survived at least until ICU discharge. The CKRT dose, filter type, and anticoagulation were similar in those who did and did not survive to ICU discharge. There were apparent practice variations by institutional ICU size.Retrospective design; limited representation from centers outside United States.In this study of children and young adults receiving CKRT approximately two-thirds survived at least until ICU discharge. While variations in dialysis mode, dose, catheter size and location, and anticoagulation were observed, survival was not detected to be associated with these parameters.

  View details for DOI 10.1053/j.ajkd.2023.12.017

  View details for PubMedID 38364956

• Time to Continuous Renal Replacement Therapy Initiation and 90-Day Major Adverse Kidney Events in Children and Young Adults. JAMA network open Gist, K. M., Menon, S., Anton-Martin, P., Bigelow, A. M., Cortina, G., Deep, A., De la Mata-Navazo, S., Gelbart, B., Gorga, S., Guzzo, I., Mah, K. E., Ollberding, N. J., Shin, H. S., Thadani, S., Uber, A., Zang, H., Zappitelli, M., Selewski, D. T. 2024; 7 (1): e2349871

  Abstract

  In clinical trials, the early or accelerated continuous renal replacement therapy (CRRT) initiation strategy among adults with acute kidney injury or volume overload has not demonstrated a survival benefit. Whether the timing of initiation of CRRT is associated with outcomes among children and young adults is unknown.To determine whether timing of CRRT initiation, with and without consideration of volume overload (VO; <10% vs ≥10%), is associated with major adverse kidney events at 90 days (MAKE-90).This multinational retrospective cohort study was conducted using data from the Worldwide Exploration of Renal Replacement Outcome Collaborative in Kidney Disease (WE-ROCK) registry from 2015 to 2021. Participants included children and young adults (birth to 25 years) receiving CRRT for acute kidney injury or VO at 32 centers across 7 countries. Statistical analysis was performed from February to July 2023.The primary exposure was time to CRRT initiation from intensive care unit admission.The primary outcome was MAKE-90 (death, dialysis dependence, or persistent kidney dysfunction [>25% decline in estimated glomerular filtration rate from baseline]).Data from 996 patients were entered into the registry. After exclusions (n = 27), 969 patients (440 [45.4%] female; 16 (1.9%) American Indian or Alaska Native, 40 (4.7%) Asian or Pacific Islander, 127 (14.9%) Black, 652 (76.4%) White, 18 (2.1%) more than 1 race; median [IQR] patient age, 8.8 [1.7-15.0] years) with data for the primary outcome (MAKE-90) were included. Median (IQR) time to CRRT initiation was 2 (1-6) days. MAKE-90 occurred in 630 patients (65.0%), of which 368 (58.4%) died. Among the 601 patients who survived, 262 (43.6%) had persistent kidney dysfunction. Of patients with persistent dysfunction, 91 (34.7%) were dependent on dialysis. Time to CRRT initiation was approximately 1 day longer among those with MAKE-90 (median [IQR], 3 [1-8] days vs 2 [1-4] days; P = .002). In the generalized propensity score-weighted regression, there were approximately 3% higher odds of MAKE-90 for each 1-day delay in CRRT initiation (odds ratio, 1.03 [95% CI, 1.02-1.04]).In this cohort study of children and young adults receiving CRRT, longer time to CRRT initiation was associated with greater risk of MAKE-90 outcomes, in particular, mortality. These findings suggest that prospective multicenter studies are needed to further delineate the appropriate time to initiate CRRT and the interaction between CRRT initiation timing and VO to continue to improve survival and reduce morbidity in this population.

  View details for DOI 10.1001/jamanetworkopen.2023.49871

  View details for PubMedID 38165673

  View details for PubMedCentralID PMC10762580

• Epidemiology of acute kidney injury in children: a report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference. Pediatric nephrology (Berlin, Germany) Sutherland, S. M., Alobaidi, R., Gorga, S. M., Iyengar, A., Morgan, C., Heydari, E., Arikan, A. A., Basu, R. K., Goldstein, S. L., Zappitelli, M. 2023

  Abstract

  The nephrology and critical care communities have seen an increase in studies exploring acute kidney injury (AKI) epidemiology in children. As a result, we now know that AKI is highly prevalent in critically ill neonates, children, and young adults. Furthermore, children who develop AKI experience greater morbidity and higher mortality. Yet knowledge gaps still exist that suggest a more comprehensive understanding of AKI will form the foundation for future efforts designed to improve outcomes. In particular, the areas of community acquired AKI, AKI in non-critically ill children, and cohorts from low-middle income countries have not been well studied. Longer-term functional outcomes and patient-centric metrics including social determinants of health, quality of life, and healthcare utilization should be the foci of the next phase of scholarship. Current definitions identify AKI-based upon evidence of dysfunction which serves as a proxy for injury; biomarkers capable of identifying injury as it occurs are likely to more accurately define populations with AKI. Despite the strength of the association, the causal and mechanistic relationships between AKI and poorer outcomes remain inadequately examined. A more robust understanding of the relationship represents a potential to identify therapeutic targets. Once established, a more comprehensive understanding of AKI epidemiology in children will allow investigation of preventive, therapeutic, and quality improvement interventions more effectively.

  View details for DOI 10.1007/s00467-023-06164-w

  View details for PubMedID 37874357

  View details for PubMedCentralID 9756303

• Advances in pediatric acute kidney injury pathobiology: a report from the 26th Acute Disease Quality Initiative (ADQI) conference. Pediatric nephrology (Berlin, Germany) Starr, M. C., Barreto, E., Charlton, J., Vega, M., Brophy, P. D., Ray Bignall, O. N., Sutherland, S. M., Menon, S., Devarajan, P., Akcan Arikan, A., Basu, R., Goldstein, S., Soranno, D. E. 2023

  Abstract

  In the past decade, there have been substantial advances in our understanding of the pathobiology of pediatric acute kidney injury (AKI). In particular, animal models and studies focused on the relationship between kidney development, nephron number, and kidney health have identified a number of heterogeneous pathophysiologies underlying AKI. Despite this progress, gaps remain in our understanding of the pathobiology of pediatric AKI.During the 26th Acute Disease Quality Initiative (ADQI) Consensus conference, a multidisciplinary group of experts discussed the evidence and used a modified Delphi process to achieve consensus on recommendations for opportunities to advance translational research in pediatric AKI. The current state of research understanding as well as gaps and opportunities for advancement in research was discussed, and recommendations were summarized.Consensus was reached that to improve translational pediatric AKI advancements, diverse teams spanning pre-clinical to epidemiological scientists must work in concert together and that results must be shared with the community we serve with patient involvement. Public and private research support and meaningful partnerships with adult research efforts are required. Particular focus is warranted to investigate the pediatric nuances of AKI, including the effect of development as a biological variable on AKI incidence, severity, and outcomes.Although AKI is common and associated with significant morbidity, the biologic basis of the disease spectrum throughout varying nephron developmental stages remains poorly understood. An incomplete understanding of factors contributing to kidney health, the diverse pathobiologies underlying AKI in children, and the historically siloed approach to research limit advances in the field. The recommendations outlined herein identify gaps and outline a strategic approach to advance the field of pediatric AKI via multidisciplinary translational research.

  View details for DOI 10.1007/s00467-023-06154-y

  View details for PubMedID 37792076

  View details for PubMedCentralID 9756303

• Advances in pediatric acute kidney injury pathobiology: a report from the 26th Acute Disease Quality Initiative (ADQI) conference PEDIATRIC NEPHROLOGY Starr, M. C., Barreto, E., Charlton, J., Vega, M., Brophy, P. D., Bignall II, O., Sutherland, S. M., Menon, S., Devarajan, P., Arikan, A., Basu, R., Goldstein, S., Soranno, D. E., ADQI 26 Workgrp 2023

  View details for DOI 10.1007/s00467-023-06154

  View details for Web of Science ID 001078763100002

• Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK). Kidney international reports Menon, S., Krallman, K. A., Arikan, A. A., Fuhrman, D. Y., Gorga, S. M., Mottes, T., Ollberding, N., Ricci, Z., Stanski, N. L., Selewski, D. T., Soranno, D. E., Zappitelli, M., Zang, H., Gist, K. M., WE-ROCK Investigators, Ahern, E., Akcan Arikan, A., Alhamoud, I., Alobaidi, R., Anton-Martin, P., Balani, S. S., Barhight, M., Basalely, A., Bigelow, A. M., Bottari, G., Cappoli, A., Ciccia, E. A., Collins, M., Colosimo, D., Cortina, G., Damian, M. A., De la Mata Navazo, S., DeAbreu, G., Deep, A., Ding, K. L., Dolan, K. J., Fernandez Lafever, S. N., Fuhrman, D. Y., Gelbart, B., Gist, K. M., Gorga, S. M., Guzzi, F., Guzzo, I., Haga, T., Harvey, E., Hasson, D. C., Hill-Horowitz, T., Inthavong, H., Joseph, C., Kaddourah, A., Kakajiwala, A., Kessel, A. D., Korn, S., Krallman, K. A., Kwiatkowski, D. M., Lee, J., Lequier, L., Kia, T. M., Mah, K. E., Marinari, E., Martin, S. D., Menon, S., Mohamed, T. H., Morgan, C., Mottes, T. A., Muff-Luett, M. A., Namachivayam, S., Neumayr, T. M., Md, J. N., O'Rourke, A., Ollberding, N. J., Pinto, M. G., Qutob, D., Raggi, V., Reynaud, S., Ricci, Z., Rumlow, Z. A., Santiago Lozano, M. J., See, E., Selewski, D. T., Serpe, C., Serratore, A., Shah, A., Shih, W. V., Shin, H. S., Slagle, C. L., Solomon, S., Soranno, D. E., Srivastava, R., Stanski, N. L., Starr, M. C., Stenson, E. K., Strong, A. E., Taylor, S. A., Thadani, S. V., Uber, A. M., Van Wyk, B., Webb, T. N., Zang, H., Zangla, E. E., Zappitelli, M. 2023; 8 (8): 1542-1552

  Abstract

  Introduction: Continuous renal replacement therapy (CRRT) is used for the symptomatic management of acute kidney injury (AKI) and fluid overload (FO). Contemporary reports on pediatric CRRT are small and single center in design. Large international studies evaluating CRRT practice and outcomes are lacking. Herein, we describe the design of a multinational collaborative.Methods: The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) is an international collaborative of pediatric specialists whose mission is to improve short- and long-term outcomes of children treated with CRRT. The aims of this multicenter retrospective study are to describe the epidemiology, liberation patterns, association of fluid balance and timing of CRRT initiation, and CRRT prescription with outcomes.Results: We included children (n= 996, 0-25 years) admitted to an intensive care unit (ICU) and treated with CRRT for AKI or FO at 32 centers (in 7 countries) from 2018 to 2021. Demographics and clinical characteristics before CRRT initiation, during the first 7 days of both CRRT, and liberation were collected. Outcomes include the following: (i) major adverse kidney events at 90 days (mortality, dialysis dependence, and persistent kidney dysfunction), and (ii) functional outcomes (functional stats scale).Conclusion: The retrospective WE-ROCK study represents the largest international registry of children receiving CRRT for AKI or FO. It will serve as a broad and invaluable resource for the field of pediatric critical care nephrology that will improve our understanding of practice heterogeneity and the association of CRRT with clinical and patient-centered outcomes. This will generate preliminary data for future interventional trials in this area.

  View details for DOI 10.1016/j.ekir.2023.05.026

  View details for PubMedID 37547524

• Consensus-Based Recommendations on Priority Activities to Address Acute Kidney Injury in Children: A Modified Delphi Consensus Statement. JAMA network open Goldstein, S. L., Akcan-Arikan, A., Alobaidi, R., Askenazi, D. J., Bagshaw, S. M., Barhight, M., Barreto, E., Bayrakci, B., Bignall, O. N., Bjornstad, E., Brophy, P. D., Chanchlani, R., Charlton, J. R., Conroy, A. L., Deep, A., Devarajan, P., Dolan, K., Fuhrman, D. Y., Gist, K. M., Gorga, S. M., Greenberg, J. H., Hasson, D., Ulrich, E. H., Iyengar, A., Jetton, J. G., Krawczeski, C., Meigs, L., Menon, S., Morgan, J., Morgan, C. J., Mottes, T., Neumayr, T. M., Ricci, Z., Selewski, D., Soranno, D. E., Starr, M., Stanski, N. L., Sutherland, S. M., Symons, J., Tavares, M. S., Vega, M. W., Zappitelli, M., Ronco, C., Mehta, R. L., Kellum, J., Ostermann, M., Basu, R. K. 2022; 5 (9): e2229442

  Abstract

  Increasing evidence indicates that acute kidney injury (AKI) occurs frequently in children and young adults and is associated with poor short-term and long-term outcomes. Guidance is required to focus efforts related to expansion of pediatric AKI knowledge.To develop expert-driven pediatric specific recommendations on needed AKI research, education, practice, and advocacy.At the 26th Acute Disease Quality Initiative meeting conducted in November 2021 by 47 multiprofessional international experts in general pediatrics, nephrology, and critical care, the panel focused on 6 areas: (1) epidemiology; (2) diagnostics; (3) fluid overload; (4) kidney support therapies; (5) biology, pharmacology, and nutrition; and (6) education and advocacy. An objective scientific review and distillation of literature through September 2021 was performed of (1) epidemiology, (2) risk assessment and diagnosis, (3) fluid assessment, (4) kidney support and extracorporeal therapies, (5) pathobiology, nutrition, and pharmacology, and (6) education and advocacy. Using an established modified Delphi process based on existing data, workgroups derived consensus statements with recommendations.The meeting developed 12 consensus statements and 29 research recommendations. Principal suggestions were to address gaps of knowledge by including data from varying socioeconomic groups, broadening definition of AKI phenotypes, adjudicating fluid balance by disease severity, integrating biopathology of child growth and development, and partnering with families and communities in AKI advocacy.Existing evidence across observational study supports further efforts to increase knowledge related to AKI in childhood. Significant gaps of knowledge may be addressed by focused efforts.

  View details for DOI 10.1001/jamanetworkopen.2022.29442

  View details for PubMedID 36178697

• A prospective multi-center quality improvement initiative (NINJA) indicates a reduction in nephrotoxic acute kidney injury in hospitalized children. Kidney international Goldstein, S. L., Dahale, D., Kirkendall, E. S., Mottes, T., Kaplan, H., Muething, S., Askenazi, D. J., Henderson, T., Dill, L., Somers, M. J., Kerr, J., Gilarde, J., Zaritsky, J., Bica, V., Brophy, P. D., Misurac, J., Hackbarth, R., Steinke, J., Mooney, J., Ogrin, S., Chadha, V., Warady, B., Ogden, R., Hoebing, W., Symons, J., Yonekawa, K., Menon, S., Abrams, L., Sutherland, S., Weng, P., Zhang, F., Walsh, K. 2019

  Abstract

  Nephrotoxic medication (NTMx) exposure is a common cause of acute kidney injury (AKI) in hospitalized children. The Nephrotoxic Injury Negated by Just-in time Action (NINJA) program decreased NTMx associated AKI (NTMx-AKI) by 62% at one center. To further test the program, we incorporated NINJA across nine centers with the goal of reducing NTMx exposure and, consequently, AKI rates across these centers. NINJA screens all non-critically ill hospitalized patients for high NTMx exposure (over three medications on the same day or an intravenous aminoglycoside over three consecutive days), and then recommends obtaining a daily serum creatinine level in exposed patients for the duration of, and two days after, exposure ending. Additionally, substitution of equally efficacious but less nephrotoxic medications for exposed patients starting the day of exposure was recommended when possible. The main outcome was AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria (increase of 50% or 0.3 mg/dl over baseline). The primary outcome measure was AKI episodes per 1000 patient-days. Improvement was defined by statistical process control methodology and confirmed by Autoregressive Integrated Moving Average (ARIMA) modeling. Eight consecutive bi-weekly measure rates in the same direction from the established baseline qualified as special cause change for special process control. We observed a significant and sustained 23.8% decrease in NTMx-AKI rates by statistical process control analysis and by ARIMA modeling; similar to those of the pilot single center. Thus, we have successfully applied the NINJA program to multiple pediatric institutions yielding decreased AKI rates.

  View details for DOI 10.1016/j.kint.2019.10.015

  View details for PubMedID 31980139