Acute Kidney Injury in Critically Ill Children: A Retrospective Analysis of Risk Factors

Abstract

Introduction: Children admitted to paediatric intensive care unit (PICU) are at risk of acute kidney injury (AKI). However, few paediatric studies have focused on the identification of factors potentially associated with the development of this condition. The aim of our study was to assess the incidence rate of AKI, identify risk factors, and evaluate clinical outcome in a large sample of critically ill children. Methods: This retrospective observational study was conducted including patients admitted to our PICU from January 2014 to December 2016. AKI was defined according to Kidney Disease: Improving Global Outcome criteria. Results: A total of 222 PICU patients out of 811 (27%) had AKI (stage I 39%, stage II 24%, stage III 37%). The most common PICU admission diagnoses in AKI cases were heart disease (38.6%), respiratory failure (16.8%) and postsurgical non-cardiac patients (11%). Hypoxic-ischaemic was the most frequent cause of AKI. Significant risk factors for AKI following multivariate analysis were age >2 months (OR 2.43; 95% CI 1.03–7.87; p = 0.05), serum creatinine at admission >44 µmol/L (OR 2.23; 95% CI 1.26–3.94; p = 0.006), presence of comorbidities (OR 1.84; 95% CI 1.03–3.30; p = 0.04), use of inotropes (OR 2.56; 95% CI 1.23–5.35; p= 0.012) and diuretics (OR 2.78; 95% CI 1.49–5.19; p = 0.001), exposure to nephrotoxic drugs (OR 1.66; 95% CI 1.01–2.91; p= 0.04), multiple organ dysfunction syndrome (OR 2.68; 95% CI 1.43–5.01; p = 0.002), and coagulopathy (OR 1.89; 95% CI 1.05–3.38, p = 0.03). AKI was associated with a significant longer PICU stay (median LOS of 8 days, interquartile range [IQR] 3–16, versus 4 days, IQR 2–8, in non-AKI patients; p < 0.001). The mortality rate resulted tenfold higher in AKI than non-AKI patients (12.6 vs. 1.2%; p < 0.001). Conclusions: The incidence of AKI in critically ill children is high, with an associated increased length of stay and risk of mortality. In the PICU setting, risk factors of AKI are multiple and mainly associated with illness severity.

Nonsteroidal anti‐inflammatory drugs associated acute kidney injury in hospitalized children: A systematic review and meta‐analysis

“…Five records did not include the outcome of the risk of AKI [19][20][21][22][23] while three studies included population that did not meet the inclusion criteria (less than 50 patients or inaccurate age classification). [24][25][26] Hence these eight studies were excluded from this meta-analysis as well. The remaining seven studies (four case-control studies and three retrospective cohort studies) [27][28][29][30][31][32][33] examining NSAID-associated AKI risk in 54 852 hospitalized pediatric patients met our inclusion criteria (Figure 1).…”

“…40 Among these intrarenal toxicities, NSAIDs are generally accessible in diverse environments, becoming a primary risk factor for a great number of people, particularly in pediatric patients. In a retrospective cohort study performed in Italy, 26 NSAIDs act as a hazardous factor for AKI that should not be overlooked in critically ill patients aged 0-20 years old. The authors claimed that the nephrotoxic drug use should be carefully monitored especially in critically ill children with major comorbidities.…”

Acute Kidney Injury: From Diagnosis to Prevention and Treatment Strategies

“…Patient age is an important non-modifiable risk factor, as the loss of renal reserve and the physiologic decline of GFR may place older patients at risk for AKI [ 38 , 39 , 40 , 41 , 42 ].…”

Artificial Intelligence in Acute Kidney Injury Risk Prediction

“…Both patient susceptibilities and exposures are important risk factors for AKI. Patient age is an important non-modifiable risk factor [34][35][36]. The loss of renal reserve and physiologic decline of glomerular filtration rate (GFR) may place older patients at risk for AKI [37,38].…”

“…Both patient susceptibilities and exposures are important risk factors for AKI. Patient age is an important non-modifiable risk factor [34][35][36]. The loss of renal reserve and physiologic decline of glomerular filtration rate (GFR) may place older patients at risk for AKI [37,38].Chronic kidney disease (CKD) is another major risk factor for AKI [38] The loss of autoregulation, abnormal vasodilation, susceptibility to antihypertensive agents and nephrotoxins, and the side effects of medication contribute to the development of AKI in CKD patients [38].Patient comorbidities, such as diabetes mellitus, hypertension, cardiovascular disease, chronic liver disease, and chronic obstructive pulmonary disease, have also been identified as important AKI predictors [15,[31][32][33]36,39,40].…”