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Nutritional and clinical factors associated with acute kidney injury development in critically ill children
Ana Luiza Cim Ribeiro de Souza1, Alberto Piovezani1, Julia Carvalho Ventura2
1Joana de Gusmão Children's Hospital, Florianópolis, Santa Catarina, Brazil.
Insights
Pediatric acute kidney injury (AKI) is linked to clinical factors like sepsis and fluid overload. Adequate protein intake may help prevent AKI in critically ill children, highlighting the need for nutritional support.
Area of Science:
- Pediatric critical care medicine
- Nephrology
- Clinical nutrition
Background:
- Acute kidney injury (AKI) is a frequent complication in pediatric intensive care units (ICUs), associated with adverse outcomes.
- Limited data exists on the relationship between nutritional status and nutrient delivery in critically ill children.
- This study investigated nutritional and clinical factors contributing to AKI development in pediatric ICU patients.
Purpose of the Study:
- To identify nutritional and clinical factors associated with the development of acute kidney injury (AKI) in critically ill pediatric patients.
- To provide insights for implementing targeted nutritional assessment and therapy protocols.
Main Methods:
- Prospective study of critically ill pediatric patients (<15 years) admitted to medical and surgical ICUs.
- Data collection included clinical, laboratory, nutritional status, and AKI parameters.
- Adjusted logistic regression analysis was used to determine odds ratios (OR) and 95% confidence intervals (95%CI).
Main Results:
- 43.5% of 108 enrolled patients developed AKI.
- Risk factors for AKI included sepsis/septic shock (OR 8.00), higher illness severity (OR 1.89), hypoalbuminemia (OR 4.11), edema (OR 3.42), and fluid overload (OR 3.52).
- Mechanical ventilation (OR 3.62) and adequate protein intake (OR 0.79) were also associated with AKI development.
Conclusions:
- Hypoalbuminemia, mechanical ventilation, fluid overload, illness severity, sepsis/septic shock, and edema are significant risk factors for AKI in pediatric ICUs.
- Adequate protein intake showed an association with AKI, underscoring its importance.
- Implementing nutritional assessment and therapy protocols is crucial for critically ill pediatric patients to mitigate AKI risk.
Background:
Acute kidney injury (AKI) is common in the pediatric intensive care unit (ICU) and is associated with poorer clinical outcomes. There is scarce data to support an association between nutritional status and nutrient delivery in critically ill pediatric patients. Therefore, the present study aimed to identify the nutritional and clinical factors associated with the development of AKI during pediatric ICU stay.
Methods:
This prospective study included critically ill pediatric patients aged < 15 years who were admitted to the medical and surgical pediatric ICU. Clinical, laboratory, nutritional status, nutritional therapy parameters, and AKI data were recorded. Adjusted logistic regression was applied and expressed as odds ratio (OR) and 95% confidence interval (95%CI). P-value < 0.05 was considered significant.
Results:
We enrolled 108 patients with a median age of 9 months (interquartile range/IQR 2.4-62.5), and 43.5% developed AKI. Sepsis/septic shock (OR 8.00; 95% CI 2.06-32.51, p = 0.003), higher severity of illness (OR 1.89; 95% CI 1.24-2.90, p = 0.003), hypoalbuminemia (OR 4.11; 95% CI 1.61-10.46, p = 0.006), edema (OR 3.42, 95% CI 1.10-10.67, p = 0.034), fluid overload (OR 3.52, 95% CI 1.56-7.96, p = 0.003), need for mechanical ventilation (OR 3.62, 95% CI 1.45-9.04, p = 0.006) and adequate protein intake (OR 0.79, 95% CI 0.63-1.00, p = 0.048) were associated with development of AKI.
Conclusions:
Hypoalbuminemia, need for mechanical ventilation, fluid overload, severity of illness, sepsis/septic shock, and edema were risk factors for AKI in pediatric ICU. Furthermore, adequate protein intake is associated with AKI during pediatric ICU stay, making it important to implement nutritional assessment and nutritional therapy protocols for critically ill pediatric patients.
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