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Acute kidney injury in a single pediatric intensive care unit in Poland: a retrospective study
Monika Miklaszewska1, Przemysław Korohoda, Alina Sobczak
1Department of Pediatric Nephrology, Jagiellonian University Medical College, Kraków, Poland.
Insights
Pediatric acute kidney injury (AKI) is increasing in pediatric intensive care units (PICUs). Lower urine output in the first week of hospitalization is a poor prognostic indicator for pediatric AKI patients.
Area of Science:
- Pediatric intensive care
- Nephrology
- Critical care medicine
Background:
- Pediatric intensive care unit (PICU) management improvements have reduced mortality.
- This success is linked to a rise in pediatric acute kidney injury (AKI), particularly in patients with multiorgan failure.
Purpose of the Study:
- To analyze the incidence, outcomes, and prognostic factors of AKI in a PICU.
- To evaluate the diagnostic utility of oliguria and early urine output in pediatric AKI.
Main Methods:
- Retrospective analysis of 25 pediatric AKI cases over 7 years.
- AKI diagnosis based on the pediatric Risk, Injury, Failure, Loss, End-stage (pRIFLE) criteria.
- Comparison of outcomes between AKI and non-AKI patients, and between survivors and non-survivors.
Main Results:
- AKI occurred in 1.24% of hospitalized children.
- AKI patients had a 40% mortality rate, 4.4 times higher than the overall PICU mortality.
- Lower mean urine output (<1.4 ml/kg/h) in the first week was associated with increased mortality (37% survival vs. 49% in non-oliguric patients).
Conclusions:
- Oliguria is not a reliable indicator for diagnosing AKI in infants under one year.
- Reduced early urine output (<1.4 ml/kg/h) in PICU is a significant negative prognostic factor for pediatric AKI.
- AKI is often diagnosed late and infrequently in the PICU setting.
Background/Aims:
The recent improvements of management of patients in pediatric intensive care units (PICU) are associated with improved outcome. However, this decrease in mortality is associated with an increased number of children with acute kidney injury (AKI), especially in patients with multiorgan failure.
Methods:
The report presents a retrospective analysis of 25 cases of AKI (assessed based on the pRIFLE criteria) in PICU within 7 years.
Results:
AKI was diagnosed in 1.24% of all hospitalized children. AKI percentage duration (as compared to the total hospitalization time) in the children who died vs. the survivors was 79.55% vs. 46.19%, respectively (p<0.05). The mortality rate of AKI patients was 40% which was 4.4-times higher as compared to the total mortality rate in PICU. The final cumulative survival ratio (FCSR) of patients meeting the oliguria criterion (which was met in 48% of AKI patients) was 37% vs. 49% in non-oliguric children. Averaged urine output values in the first week of hospitalization in the deceased vs. survivors were 1.49 vs. 2.57 ml/kg/h, respectively (p<0.05).
Conclusions:
Oliguria should not be considered as a sensitive parameter for AKI diagnosing in children below one year of age. A decreased mean urine output in the first week of PICU hospitalization (less than 1.4 ml/kg/h) should be considered as a poor prognostic factor. In many cases AKI was diagnosed too infrequently and too late.
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