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A Study of Acute Kidney Injury in a Tertiary Care Pediatric Intensive Care Unit

Akanksha C Parikh1, Milind S Tullu1

  • 1Department of Pediatrics, Seth G.S. Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India.

Journal of Pediatric Intensive Care
|November 8, 2021
PubMed

Insights

This study found a high incidence of acute kidney injury (AKI) in critically ill children, with infancy, hypovolemia, shock, and sepsis as key risk factors. AKI severity did not significantly impact mortality or length of stay.

Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Clinical Research

Background:

  • Acute kidney injury (AKI) is a significant concern in pediatric intensive care units (PICUs).
  • Understanding AKI's incidence, severity, and risk factors is crucial for improving outcomes in critically ill children.

Purpose of the Study:

  • To determine the incidence, severity, and risk factors of AKI in a tertiary care PICU.
  • To assess the impact of AKI and its severity on mortality and length of hospital and PICU stays.

Main Methods:

  • Prospective observational study of 220 children (1 month-12 years) admitted to the PICU over 13 months.
  • AKI diagnosed and staged using pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE) criteria based on creatinine clearance changes.
  • Risk factors and outcomes (mortality, PICU/hospital stay) were evaluated.

Main Results:

  • 161 out of 220 patients (73.2%) developed AKI, with the majority in the 'Failure' grade (57.1%).
  • Significant risk factors included infancy, hypovolemia, shock, and sepsis.
  • Mortality, PICU stay, and hospital stay were comparable between patients with and without AKI, and across different AKI severity grades.

Conclusions:

  • Critically ill children exhibit a high incidence of AKI, particularly severe 'Failure' grade.
  • Infancy and common PICU conditions like sepsis, hypovolemia, and shock are significant predisposing factors for AKI.
  • Despite high incidence, AKI severity did not significantly influence mortality or length of stay in this cohort.

Keywords:
acute kidney injuryhospital staymortalitypRIFLE criteriapediatric intensive care unitrenalrisk factors

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