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Risk Factors of Acute Kidney Injury in Critically Ill Children
Morgan B Slater1, Andrea Gruneir, Paula A Rochon
11Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada. 2Child Health Evaluative Sciences, The Research Institute, The Hospital for Sick Children, Toronto, ON, Canada. 3Department of Family Medicine, University of Alberta, Edmonton, AB, Canada. 4Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. 5Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. 6Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. 7Department of Medicine, University of Toronto, Toronto, ON, Canada. 8Division of Orthopedic Surgery, The Hospital for Sick Children, Toronto, ON, Canada. 9Department of Surgery, University of Toronto, Toronto, ON, Canada. 10Department of Pediatrics, University of Toronto, Toronto, ON, Canada. 11Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, ON, Canada. 12Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Insights
Acute kidney injury (AKI) affects nearly a quarter of critically ill children in the ICU. Nephrotoxic medications are the leading modifiable risk factor, highlighting the need for targeted interventions to prevent AKI.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Clinical Research
Background:
- Acute kidney injury (AKI) is a significant complication in critically ill children.
- Preexisting conditions and treatments contribute to AKI development during intensive care unit (ICU) stays.
Purpose of the Study:
- To determine the frequency of AKI in critically ill children.
- To identify factors associated with AKI development before and during ICU admission.
Main Methods:
- A cohort study was conducted in a university-affiliated pediatric ICU.
- Included 3,865 pediatric patients admitted between January 2006 and June 2009.
- Excluded patients with pre-existing renal failure or short ICU stays.
Main Results:
- 23.7% of pediatric patients developed AKI, defined by Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) criteria.
- Risk factors included urgent ICU admission (aOR=1.88), respiratory dysfunction (aOR=2.90), and extracorporeal membrane oxygenation (aOR=2.72).
- Nephrotoxic medication administration during ICU stay was the strongest risk factor (aOR=3.37).
Conclusions:
- This study is the largest to evaluate RIFLE-defined AKI in critically ill children.
- Identified potentially modifiable risk factors, notably nephrotoxic medications.
- Findings can inform interventions to reduce AKI and improve outcomes in critically ill children.
Objectives:
Acute kidney injury may be promoted by critical illness, preexisting medical conditions, and treatments received both before and during ICU admission. We aimed to estimate the frequency of acute kidney injury during ICU treatment and to determine factors, occurring both before and during the ICU stay, associated with the development of acute kidney injury.
Design:
Cohort study of critically ill children.
Setting:
University-affiliated PICU.
Patients:
Eligible patients were admitted to the ICU between January 2006 and June 2009. We excluded those admitted with known primary renal failure, chronic renal failure or postrenal transplant, conditions with known renal complications, or metabolic conditions treated with dialysis. Patients were also excluded if they had a short ICU stay (< 6 hr) and those who had no creatinine or urine output measurements during their ICU stay.
Interventions:
None.
Measurements And Main Results:
Of the 3,865 pediatric patients who met the inclusion criteria, 915 (23.7%) developed acute kidney injury, as classified by the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease criteria, during their ICU stay. Patients at high risk for development of acute kidney injury included those urgently admitted to the ICU (adjusted odds ratio, 1.88), those who developed respiratory dysfunction during their ICU care (adjusted odds ratio, 2.90), and those who treated with extracorporeal membrane oxygenation (adjusted odds ratio, 2.72). The single greatest risk factor for acute kidney injury was the administration of nephrotoxic medications during ICU admission (adjusted odds ratio, 3.37).
Conclusions:
This study, the largest evaluating the incidence of RIFLE-defined acute kidney injury in critically ill children, found that one-quarter of patients admitted to the ICU developed acute kidney injury. We identified a number of potentially modifiable risk factors, the largest of which was the administration of nephrotoxic medication. The results of this study may be used to inform targeted interventions to reduce acute kidney injury and improve the outcomes of critically ill children.
Related Concept Videos
01:22Acute Kidney Injury I: Introduction
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:29Acute Kidney Injury II: Pathophysiology
01:20Acute Kidney Injury V: Interprofessional Care
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01:29Acute Kidney Injury III: Clinical Manifestations