Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit

Schneider, James; Khemani, Robinder G.; Grushkin, Carl M.; Bart, Robert D.

doi:10.1097/ccm.0b013e3181cd12e1

Cited by 291 publications

(268 citation statements)

References 41 publications

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“…AKI has been identified as a risk factor for adverse outcomes among hospitalized children in both general and critical care settings (3)(4)(5). AKI is common in hospitalized adults with idiopathic NS, with up to 34% meeting any RIFLE criteria; however little is known about AKI in children with idiopathic NS (6).…”

Section: Introductionmentioning

confidence: 99%

AKI in Children Hospitalized with Nephrotic Syndrome

Rheault¹,

Zhang²,

Selewski³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Children with nephrotic syndrome can develop life-threatening complications, including infection and thrombosis. While AKI is associated with adverse outcomes in hospitalized children, little is known about the epidemiology of AKI in children with nephrotic syndrome. The main objectives of this study were to determine the incidence, epidemiology, and hospital outcomes associated with AKI in a modern cohort of children hospitalized with nephrotic syndrome.Design, setting, participants, & measurements Records of children with nephrotic syndrome admitted to 17 pediatric nephrology centers across North America from 2010 to 2012 were reviewed. AKI was classified using the pediatric RIFLE definition.Results AKI occurred in 58.6% of 336 children and 50.9% of 615 hospitalizations (27.3% in stage R, 17.2% in stage I, and 6.3% in stage F). After adjustment for race, sex, age at admission, and clinical diagnosis, infection (odds ratio, 2.24; 95% confidence interval, 1.37 to 3.65; P=0.001), nephrotoxic medication exposure (odds ratio, 1.35; 95% confidence interval, 1.11 to 1.64; P=0.002), days of nephrotoxic medication exposure (odds ratio, 1.10; 95% confidence interval, 1.05 to 1.15; P,0.001), and intensity of medication exposure (odds ratio, 1.34; 95% confidence interval, 1.09 to 1.65; P=0.01) remained significantly associated with AKI in children with nephrotic syndrome. Nephrotoxic medication exposure was common in this population, and each additional nephrotoxic medication received during a hospitalization was associated with 38% higher risk of AKI. AKI was associated with longer hospital stay after adjustment for race, sex, age at admission, clinical diagnosis, and infection (difference, 0.45 [log]days; 95% confidence interval, 0.36 to 0.53 [log]days; P,0.001).Conclusions AKI is common in children hospitalized with nephrotic syndrome and should be deemed the third major complication of nephrotic syndrome in children in addition to infection and venous thromboembolism. Risk factors for AKI include steroid-resistant nephrotic syndrome, infection, and nephrotoxic medication exposure. Children with AKI have longer hospital lengths of stay and increased need for intensive care unit admission.

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Section: Introductionmentioning

confidence: 99%

AKI in Children Hospitalized with Nephrotic Syndrome

Rheault¹,

Zhang²,

Selewski³

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…Higher AKI rates have striking implications, because AKI is associated with increased mortality and greater morbidity (4)(5)(6). In adults, a creatinine increase as modest as 0.3 mg/ dl is associated with a fourfold increase in mortality (4); critically ill pediatric patients with AKI severe enough to require dialysis experience mortality rates of 30%-50% (7,8).…”

Section: Introductionmentioning

confidence: 99%

“…In adults, a creatinine increase as modest as 0.3 mg/ dl is associated with a fourfold increase in mortality (4); critically ill pediatric patients with AKI severe enough to require dialysis experience mortality rates of 30%-50% (7,8). Children with AKI experience longer hospitalizations, prolonged intensive care unit (ICU) stays, and greater need for mechanical ventilation (6,9). Additionally, children who survive AKI are likely to experience residual renal abnormalities; proteinuria, hypertension, and reduced GFRs persist in up to 60% of AKI survivors (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

AKI in Hospitalized Children

Sutherland

Ji²,

Sheikhi³

et al. 2013

Clinical Journal of the American Society of Nephrology

224

154

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SummaryBackground and objectives Although AKI is common among hospitalized children, comprehensive epidemiologic data are lacking. This study characterizes pediatric AKI across the United States and identifies AKI risk factors using high-content/high-throughput analytic techniques.Design, setting, participants, & measurements For the cross-sectional analysis of the 2009 Kids Inpatient Database, AKI events were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Demographics, incident rates, and outcome data were analyzed and reported for the entire AKI cohort as well as AKI subsets. Statistical learning methods were applied to the highly imbalanced dataset to derive AKI-related risk factors.Results Of 2,644,263 children, 10,322 children developed AKI (3.9/1000 admissions). Although 19% of the AKI cohort was #1 month old, the highest incidence was seen in children 15-18 years old (6.6/1000 admissions); 49% of the AKI cohort was white, but AKI incidence was higher among African Americans (4.5 versus 3.8/1000 admissions). In-hospital mortality among patients with AKI was 15.3% but higher among children #1 month old (31.3% versus 10.1%, P,0.001) and children requiring critical care (32.8% versus 9.4%, P,0.001) or dialysis (27.1% versus 14.2%, P,0.001). Shock (odds ratio, 2.15; 95% confidence interval, 1.95 to 2.36), septicemia (odds ratio, 1.37; 95% confidence interval, 1.32 to 1.43), intubation/mechanical ventilation (odds ratio, 1.2; 95% confidence interval, 1.16 to 1.25), circulatory disease (odds ratio, 1.47; 95% confidence interval, 1.32 to 1.65), cardiac congenital anomalies (odds ratio, 1.2; 95% confidence interval, 1.13 to 1.23), and extracorporeal support (odds ratio, 2.58; 95% confidence interval, 2.04 to 3.26) were associated with AKI.Conclusions AKI occurs in 3.9/1000 at-risk US pediatric hospitalizations. Mortality is highest among neonates and children requiring critical care or dialysis. Identified risk factors suggest that AKI occurs in association with systemic/multiorgan disease more commonly than primary renal disease.

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“…Reported incidences vary widely, between 4.5% and 82%, depending on the definition used and the population studied (1)(2)(3)(4)(5)(6). Moreover, AKI is an independent risk factor for prolonged mechanical ventilation and pediatric ICU mortality (1,4). Recently, our group and other research groups reported high incidences of AKI in children treated with extracorporeal membrane oxygenation (ECMO), who tend to be the most critically ill admitted to an ICU (7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

CKD and Hypertension during Long-Term Follow-Up in Children and Adolescents Previously Treated with Extracorporeal Membrane Oxygenation

Zwiers¹,

IJsselstijn²,

Rosmalen³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Many children receiving extracorporeal membrane oxygenation develop AKI. If AKI leads to permanent nephron loss, it may increase the risk of developing CKD. The prevalence of CKD and hypertension and its predictive factors during long-term follow-up of children and adolescents previously treated with neonatal extracorporeal membrane oxygenation were determined.Design, setting, participants, & measurements Between November of 2010 and February of 2014, neonatal survivors of extracorporeal membrane oxygenation who visited the prospective follow-up program at 1, 2, 5, 8, 12, and 18 years of age were screened for CKD and hypertension (BP$95th percentile of reference values). CKD was suspected in children with either an eGFR,90 ml/min per 1.73 m 2 or proteinuria (urinary protein-tocreatinine ratio .0.50 for children ages #24 months and .0.20 at .24 months). The RIFLE classification (risk, injury, or failure as 150%, 200%, or 300% of serum creatinine reference values) was used to define AKI during extracorporeal membrane oxygenation without preemptive hemofiltration.Results Median follow-up of 169 screened participants was 8.2 years (interquartile range=5.2-12.1 years). Nine children had a lower eGFR, but all rates were .60 ml/min per 1.73 m 2 . Proteinuria was observed in 20 children (median=0.26 mg protein/mg creatinine; interquartile range=0.23-0.32 mg protein/mg creatinine), and 32 children had hypertension. Only history of AKI was associated with CKD (P=0.004). Children with RIFLE scores injury and failure had 4.3 times higher odds of CKD signs or hypertension than those without AKI (95% confidence interval, 1.6 to 12.1; P=0.004).Conclusions Altogether, 54 participants (32%) had at least one sign of CKD and/or hypertension. However, most values were marginally abnormal, with no immediate consequences for clinical care. Nevertheless, a prevalence of 32% clearly indicates that survivors of neonatal extracorporeal membrane oxygenation, especially those with AKI, are at risk of a more rapid decline of kidney function with increasing age. Therefore, screening for CKD development in adulthood is recommended.

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Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit

Abstract: RIFLE criteria serves well to describe acute kidney injury in critically ill pediatric patients.

Cited by 291 publications

References 41 publications

AKI in Children Hospitalized with Nephrotic Syndrome

AKI in Children Hospitalized with Nephrotic Syndrome

AKI in Hospitalized Children

CKD and Hypertension during Long-Term Follow-Up in Children and Adolescents Previously Treated with Extracorporeal Membrane Oxygenation

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