Acute Kidney Injury in Pediatric Acute Respiratory Distress Syndrome

Area of Science:

• Pediatric Critical Care Medicine
• Nephrology
• Pulmonology

Background:

• Acute respiratory distress syndrome (ARDS) is a severe lung condition in children.
• Acute kidney injury (AKI) is a common complication in critically ill children.
• The relationship between ARDS and AKI in pediatric populations requires further investigation.

Purpose of the Study:

• To determine the incidence and risk factors of AKI in children with ARDS.
• To evaluate the impact of AKI on patient outcomes, including hospital stay and mortality.
• To identify predictors for AKI in pediatric ARDS patients.

Main Methods:

• A retrospective, single-center study was conducted at a tertiary care children's hospital.
• Included were pediatric patients (<18 years) with ARDS requiring invasive mechanical ventilation (MV) between July 2010 and July 2013.
• AKI was diagnosed using the p-RIFLE criteria.

Main Results:

• Of 115 children with ARDS, 74 (64%) developed AKI.
• AKI was associated with lower Pao2/Fio2 ratio, increased need for inotropes and diuretics, and higher ventilatory support requirements (higher oxygenation index, PEEP, mean airway pressure, Fio2).
• Patients with AKI experienced significantly longer hospital stays but not increased ICU stay, duration of MV, or mortality. A multivariable model predicted AKI with an AUC of 0.75.

Conclusions:

• Pediatric patients with ARDS exhibit a high incidence of AKI.
• The presence of AKI in pediatric ARDS is linked to increased morbidity, particularly prolonged hospitalization.
• Predictive models incorporating ventilatory parameters and clinical factors show promise for early AKI detection in this population.