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A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
Pediatric Risk, Injury, Failure, Loss, End-Stage renal disease score identifies acute kidney injury and predicts
Yadira A Soler1, Mariely Nieves-Plaza, Mónica Prieto
1Department of Pediatric Critical Care, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico. ysoler@hotmail.com
Insights
Pediatric Risk, Injury, Failure, Loss, End-Stage renal disease (pRIFLE) criteria effectively identified acute kidney injury in critically ill children. High pRIFLE scores and fluid overload predicted increased morbidity and mortality, aiding early intervention.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Medicine
Background:
- Acute kidney injury (AKI) is a significant concern in critically ill pediatric patients.
- Characterizing AKI patterns and identifying predictive tools are crucial for improving outcomes.
Purpose of the Study:
- To evaluate the utility of the Pediatric Risk, Injury, Failure, Loss, End-Stage renal disease (pRIFLE) criteria in classifying AKI in critically ill children.
- To determine if pRIFLE scores can predict morbidity and mortality in this patient population.
Main Methods:
- Prospective cohort study conducted in a multidisciplinary, tertiary care pediatric intensive care unit (PICU).
- 266 patients admitted to the PICU between November 2009 and November 2010 were analyzed.
- No specific interventions were applied; the study focused on observational data.
Main Results:
- The incidence of AKI in the PICU was 27.4%, with 83.5% of cases presenting within 72 hours of admission.
- Patients with AKI were younger, had lower weight, and were more likely to experience fluid overload (≥10%), receive inotropic support, diuretics, or aminoglycosides.
- Fluid overload (≥10%) independently predicted morbidity and mortality. pRIFLE-defined AKI and failure categories predicted mortality, hospital length of stay, and PICU length of stay.
Conclusions:
- pRIFLE criteria and fluid overload (≥10%) are significant predictors of increased morbidity and mortality in critically ill pediatric patients with AKI.
- Implementing pRIFLE scoring and monitoring fluid overload upon admission can facilitate early interventions for AKI in critically ill children.
Objectives:
To determine whether Pediatric Risk, Injury, Failure, Loss, End-Stage renal disease (pRIFLE) criteria serve to characterize the pattern of acute kidney injury in critically ill pediatric patients. To identify if pRIFLE score will predict morbidity and mortality in our patient's cohort.
Design:
Prospective cohort.
Setting:
Multidisciplinary, tertiary care, ten-bed PICU.
Patients:
A total of 266 patients admitted to PICU from November 2009 to November 2010.
Interventions:
None.
Measurements And Main Results:
The incidence of acute kidney injury in the PICU was 27.4%, of which 83.5% presented within 72 hours of admission to the PICU. Patients with acute kidney injury were younger; weighed less; were more likely to be on fluid overload greater than or equal to 10%; and were more likely to be on inotropic support, diuretics, or aminoglycosides. No difference in gender, use of other nephrotoxins, or mechanical ventilation was observed. Fluid overload greater than or equal to 10% was an independent predictor of morbidity and mortality. In multivariate analysis, acute kidney injury and failure categories, as defined by pRIFLE, predicted mortality, hospital length of stay, and PICU length of stay.
Conclusions:
In this cohort of critically ill pediatric patients, acute kidney injury identified by pRIFLE and fluid overload greater than or equal to 10% predicted increased morbidity and mortality. Implementation of pRIFLE scoring and close monitoring of fluid overload upon admission may help develop early interventions to prevent and treat acute kidney injury in critically ill children.
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