Acute Kidney Injury in Critically Ill Children: A Retrospective Single-Center Study

Area of Science:

• Pediatric Critical Care Medicine
• Nephrology
• Pediatric Intensive Care Unit (PICU) Research

Background:

• Acute kidney injury (AKI) significantly impacts morbidity and mortality in critically ill children.
• Understanding AKI's incidence and characteristics in pediatric intensive care units (PICUs) is vital for improving patient outcomes.

Purpose of the Study:

• To determine the incidence, clinical characteristics, and outcomes of AKI in a tertiary pediatric intensive care unit (PICU).
• To identify factors associated with AKI development and mortality in critically ill children.

Main Methods:

• Retrospective observational cohort study conducted from January 2018 to December 2022.
• Included children aged 29 days to 14 years admitted to the PICU for at least 48 hours.
• AKI defined and staged using the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) criteria; excluded neonates, CKD patients, and elective admissions.

Main Results:

• The incidence of AKI was 13.5% (162/1200 admissions), with Stages 1, 2, and 3 occurring in 27.2%, 39.5%, and 33.3% of cases, respectively.
• Increased AKI severity correlated with younger age, higher inotropic support needs, and prolonged mechanical ventilation (p < 0.05).
• PICU mortality was 16.7% overall, rising to 27.8% in Stage 3 AKI (p = 0.006); inotropic support, complications, and PRISM IV score predicted mortality.

Conclusions:

• AKI severity is a significant predictor of adverse clinical outcomes in critically ill children.
• Effective management strategies include early AKI recognition, hemodynamic stabilization, prompt nephrology consultation, and diligent post-AKI follow-up.