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Morbimortality associated to acute kidney injury in patients admitted to pediatric intensive care units
J C Gómez Polo1, A J Alcaraz Romero1, M A Gil-Ruíz Gil-Esparza1
1Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España.
Insights
Acute kidney injury (AKI) in critically ill children significantly increases morbidity and mortality. The severity of renal injury directly correlates with poorer outcomes, including longer hospital stays and increased need for mechanical ventilation.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Epidemiology
Background:
- Acute kidney injury (AKI) is a significant concern in Pediatric Intensive Care Units (PICUs).
- Defining and quantifying AKI's impact is crucial for improving patient outcomes.
Purpose of the Study:
- To describe the morbimortality associated with acute kidney injury (AKI) in a PICU.
- To utilize the pediatric adaptation of the RIFLE criteria for AKI classification.
Main Methods:
- Retrospective cohort study of 320 children admitted to a tertiary care PICU in 2011.
- Exclusion of neonates and renal transplant recipients.
- AKI defined and classified using the pediatric RIFLE criteria; morbimortality assessed via PICU/hospital stays, mechanical ventilation use, and mortality.
Main Results:
- 128 out of 315 eligible children developed AKI (40.6%).
- Children with AKI experienced significantly longer PICU stays (6.0 vs. 3.5 days) and hospital stays (17 vs. 10 days).
- AKI was an independent factor for increased morbidity, with a dose-response relationship between AKI severity and adverse outcomes.
Conclusions:
- Development of AKI in critically ill children is linked to increased morbimortality.
- The degree of renal injury is proportional to the severity of morbimortality.
Aim:
To describe the morbimortality associated to the development of acute kidney injury (AKI) defined by the pediatric adaptation of the RIFLE criteria in a Pediatric Intensive Care Unit (PICU).
Design:
A retrospective cohort study was carried out.
Setting:
Children admitted to a PICU in a tertiary care hospital. Patients or participants A total of 320 children admitted to a tertiary care hospital PICU during the year 2011. Neonates and renal transplant patients were excluded. Primary endpoints AKI was defined and classified according to the pediatric adaptation to the RIFLE criteria. PICU and hospital stays, use of mechanical ventilation and mortality were used to evaluate morbimortality.
Results:
A total of 315 children met the inclusion criteria, with a median age of 19 months (range 6-72). Of these patients, 128 presented AKI (73 reached the Risk category and 55 reached the Injury and Failure categories). Children with AKI presented a longer PICU stay (6.0 [4.0-12.5] vs. 3.5 [2.0-7.0] days) and hospital stay (17 [10-32] vs. 10 [7-15] days), and a greater need for mechanical ventilation (61.7 vs. 36.9%). The development of AKI was an independent factor of morbidity, associated with a longer PICU and hospital stay, and with a need for longer mechanical ventilation, with a proportional relationship between increasing morbidity and the severity of AKI.
Conclusion:
The development of AKI in critically ill children is associated with increased morbimortality, which is proportional to the severity of renal injury.
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