Acute kidney injury in a Pediatric Intensive Care Unit
DOI:
https://doi.org/10.25753/BirthGrowthMJ.v28.i1.14855Keywords:
acute kidney injury, children, pediatric intensive care, risk factorsAbstract
Background and aims: Acute kidney injury (AKI) is a common condition in Pediatric Intensive Care setup and has been associated with increased mortality and morbidity. The aim of this study was to determine incidence, risk factors, and outcome of AKI in a Pediatric Intensive Care Unit (PICU).
Materials and methods: An exploratory study was conducted using prospective data collected from July to December 2017. Clinical and biochemical data from all patients admitted to PICU was recorded. Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used for diagnosis. Patients with hospital stay shorter than 48 hours and with previously documented kidney disease were excluded.
Results: During the study period, 32 of 112 children developed AKI (28.6%). Median time of diagnosis was on the second day of admission.
Overall, 59.4% of children fulfilled creatinine criteria, 68.8% urinary output criteria, and 28.1%, both. KDIGO stages 1, 2 and 3 accounted for 50.0%, 28.1%, and 21.9% of cases, respectively. Total renal function recovery occurred in 56.3% of cases, partial recovery in 28.1%, and 15.6% of cases did not recover. Invasive ventilation (p=0.028), need for vasoactive drugs (p=0.043), and shock (p=0.043) were independent risk factors for AKI. Mortality was higher in AKI (15.6%) than in non-AKI (1.3%) patients (p=0.007).
Discussion: AKI is common in PICU setting, especially in the first days of admission. Both serum creatinine and urinary output criteria should be considered for diagnosis. Use of mechanical ventilation and/or vasoactive drugs and shock are common risk factors and should elicit careful monitoring and prompt treatment.
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References
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34. Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007; 71:1028–35.
35. Soler YA, Nives-Plaza M, Prieto M, Jesús RG-D, Suárez-Riviera M. pRIFLE (Pediatric Risk, Injury, Failure, Loss, End Stage Renal Disease) score identifies Acute Kidney Injury and predicts mortality in critically ill children: a prospective study. Pediatr Crit Care Med. 2013; 14:e189–95.
36. Krishnamurthy S, Narayanan P, Prabha S, Mondal N, Mahadevan S, Srinivasan S, et al. Clinical profile of acute kidney injury in a pediatric intensive care unit from Southern India: A prospective observational study. Indian J Crit Care Med. 2013; 17:207–13.
37. van den Akker JPC, Egal M, Groeneveld JAB. Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: a systematic review and meta-analysis. Crit Care. 2013; 17:R98-39.
38. Bellomo R, Wan L, May C. Vasoactive drugs and acute kidney injury. Crit Care Med. 2008; 36:179–86.
39. Lauschke A, Teichgräber UKM, Frei U, Eckardt K-U. “Low-dose” dopamine worsens renal perfusion in patients with acute renal failure. Kidney Int. 2006; 69:1669–74.
40. Haines RW, Lin S-P, Hewson R, Kirwan CJ, Torrance HD, O’Dwyer MJ, et al. Acute Kidney Injury in Trauma Patients Admitted to Critical Care: Development and Validation of a Diagnostic Prediction Model. Sci Rep. 2018; 8:3665.
2. Nichols DG, Shaffner DH. Rogers’ Textbook of Pediatric Intensive Care. 2015.
3. Keenswijk W, Vanmassenhove J, Raes A, Dhont E, VandeWalle J. Epidemiology and outcome of acute kidney injury in children, a single center study. Acta Clin Belg. 2017; 3286:1–8.
4. Sutherland SM, Byrnes JJ, Kothari M, Longhurst CA, Dutta S, Garcia P, et al. AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions. Clin J Am Soc Nephrol. 2015; 10:554–61.
5. Miklaszewska M, Korohoda P, Sobczak A, Horbaczewska A, Filipiak A, Zachwieja K, et al. Acute kidney injury in a single pediatric intensive care unit in poland: A retrospective study. Kidney Blood Press Res. 2014; 39:28–39.
6. Alkandari O, Eddington KA, Hyder A, Gauvin F, Ducruet T, Gottesman R, et al. Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study. Crit Care. 2011; 15:R146.
7. Marin T, Derossett B, Bhatia J. Urinary Biomarkers to Predict Neonatal Acute Kidney Injury. J Perinat Neonat Nurs. 2018; 0:1–9.
8. Koeze J, Keus F, Dieperink W, Van der Horst ICC, Zijlstra JG, Van Meurs M. Incidence, timing and outcome of AKI in critically ill patients varies with the definition used and the addition of urine output criteria. BMC Nephrol. 2017; 18:1–9.
9. Nelson Sanchez-Pinto L, Goldstein SL, Schneider JB, Khemani RG. Association between progression and improvement of acute kidney injury and mortality in critically ill children. Pediatr Crit Care Med. 2015; 16:703–10.
10. Glanzmann C, Frey B, Vonbach P, Meier CR. Drugs as risk factors of acute kidney injury in critically ill children. Pediatr Nephrol. 2016; 31:145–51.
11. Bonazza S, Bresee LC, Kraft T, Ross BC, Dersch-Mills D. Frequency of and Risk Factors for Acute Kidney Injury Associated With Vancomycin Use in the Pediatric Intensive Care Unit. J Pediatr Pharmacol Ther. 2016; 21:486–93.
12. Schneider J, Khemani R, Grushkin C, Bart R. Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med. 2010; 38:933–9.
13. Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL. Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults. N Engl J Med. 2017; 376:11–20.
14. American Society of Nephrology Renal Research Report. J Am Soc Nephrol. 2005; 16:1886–903.
15. Mussap M, Noto A, Fanos V, Van Den Anker JN. Emerging biomarkers and metabolomics for assessing toxic nephropathy and acute kidney injury (AKI) in neonatology. Biomed Res Int. 2014; 602526
16. Coca SG, Yalavarthy R, Concato J, Parikh CR. Biomarkers for the diagnosis and risk stratification of acute kidney injury: a systematic review. Kidney Int. 2008; 73:1008–16.
17. Serna-Higuita LM, Nieto-Ríos JF, Contreras-Saldarriaga JE, Escobar-Cataño JF, Gómez-Ramírez LA, Montoya-Giraldo JD, et al. Risk factors for acute kidney injury in a pediatric intensive care unit: a retrospective cohort study. Medwave. 2017; 17:e6940.
18. Gupta S, Sengar GS, Meti PK, Lahoti A, Beniwal M, Kumawat M. Acute kidney injury in Pediatric Intensive Care Unit: Incidence, risk factors, and outcome. Indian J Crit Care Med. 2016; 20:526– 9.
19. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012; 2:1–138.
20. Ceriotti F, Boyd JC, Klein G, Henny J, Queraltó J, Kairisto V, et al. Reference intervals for serum creatinine concentrations: Assessment of available data for global application. Clin Chem. 2008; 54:559–66.
21. Mendes da Silva C, do Carmo C, Pinto C, Januário G. Acute kidney injury in children at a Portuguese tertiary care center.
22. Schoenfeld DA, Bernard GR. Statistical evaluation of ventilatorfree days as an efficacy measure in clinical trials of treatments for acute respiratory distress syndrome. Crit Care Med. 2002; 30:1772–7.
23. Straney L, Clements A, Parslow RC, Pearson G, Shann F, Alexander J, et al. Paediatric index of mortality 3: An updated model for predicting mortality in pediatric intensive care. Pediatr Crit Care Med. 2013; 14:673–81.
24. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Pediatrics. 2004; 114:555–76.
25. Basu RK, Devarajan P, Wong H, Wheeler DS. An update and review of acute kidney injury in pediatrics. Pediatr Crit Care Med. 2011; 12:339–47.
26. Kari JA, Alhasan KA, Shalaby MA, Khathlan N, Safdar OY, Al Rezgan SA, et al. Outcome of pediatric acute kidney injury: a multicenter prospective cohort study. Pediatr Nephrol. 2018; 33:335-40. doi: 10.1007/s00467-017-3786-1. Epub 2017.
27. Palermo J, Dart AB, De Mello A, Devarajan P, Gottesman R, Garcia Guerra G, et al. Biomarkers for Early Acute Kidney Injury Diagnosis and Severity Prediction: A Pilot Multicenter Canadian Study of Children Admitted to the ICU. Pediatr Crit Care Med. 2017; 18:e235–44.
28. Zappitelli M. Epidemiology and Diagnosis of Acute Kidney Injury. Semin Nephrol. 2008; 28:436–46.
29. Zappitelli M, Parikh CR, Akcan-Arikan A, Washburn KK, Moffett BS, Goldstein SL. Ascertainment and epidemiology of acute kidney injury varies with definition interpretation. Clin J Am Soc Nephrol. 2008; 3:948–54.
30. Hessey E, Ali R, Dorais M, Morissette G, Pizzi M, Rink N, et al. Evaluation of height-dependent and height-independent methods of estimating baseline serum creatinine in critically ill children. Pediatr Nephrol. 2017; 32:1953–62.
31. Ghobrial EE, Elhouchi SZ, Eltatawy SS, Beshara LO. Risk factors associated with acute kidney injury in extremely. Vol. 29. 2018. p. 81–7.
32. Mehta P, Sinha A, Sami A, Hari P, Kalaivani M, Gulati A, et al. Incidence of acute kidney injury in hospitalized children. Indian Pediatr. 2012; 49:537–42.
33. Sanchez-Pinto LN, Khemani RG. Development of a Prediction Model of Early Acute Kidney Injury in Critically Ill Children Using Electronic Health Record Data. Pediatr Crit Care Med. 2016; 17:508–15.
34. Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007; 71:1028–35.
35. Soler YA, Nives-Plaza M, Prieto M, Jesús RG-D, Suárez-Riviera M. pRIFLE (Pediatric Risk, Injury, Failure, Loss, End Stage Renal Disease) score identifies Acute Kidney Injury and predicts mortality in critically ill children: a prospective study. Pediatr Crit Care Med. 2013; 14:e189–95.
36. Krishnamurthy S, Narayanan P, Prabha S, Mondal N, Mahadevan S, Srinivasan S, et al. Clinical profile of acute kidney injury in a pediatric intensive care unit from Southern India: A prospective observational study. Indian J Crit Care Med. 2013; 17:207–13.
37. van den Akker JPC, Egal M, Groeneveld JAB. Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: a systematic review and meta-analysis. Crit Care. 2013; 17:R98-39.
38. Bellomo R, Wan L, May C. Vasoactive drugs and acute kidney injury. Crit Care Med. 2008; 36:179–86.
39. Lauschke A, Teichgräber UKM, Frei U, Eckardt K-U. “Low-dose” dopamine worsens renal perfusion in patients with acute renal failure. Kidney Int. 2006; 69:1669–74.
40. Haines RW, Lin S-P, Hewson R, Kirwan CJ, Torrance HD, O’Dwyer MJ, et al. Acute Kidney Injury in Trauma Patients Admitted to Critical Care: Development and Validation of a Diagnostic Prediction Model. Sci Rep. 2018; 8:3665.
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2019-04-10
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Martins JR, Pereira C, Aquino C, Pinto C, Dias A, Carvalho L. Acute kidney injury in a Pediatric Intensive Care Unit. REVNEC [Internet]. 2019Apr.10 [cited 2024Apr.28];28(1):9-17. Available from: https://revistas.rcaap.pt/nascercrescer/article/view/14855
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