Peritoneal Dialysis with Rigid Catheters in Children with Acute Kidney Injury: A Single-Centre Experience

2022 ◽  
Author(s):  
Manasi Garg ◽  
Lalitha A. V. ◽  
Anil Vasudevan
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Critically Ill ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Renal Outcome ◽  
Critically Ill Children ◽  
Care Hospital ◽  
Major Life

AbstractPeritoneal dialysis (PD) is a simple and preferred modality of dialysis for children with acute kidney injury (AKI) in resource poor countries. The aim of the study is to evaluate the utility and safety of acute PD using rigid catheter in critically ill children admitted to pediatric intensive care unit (PICU) with emphasis on short-term patient and renal outcome and complications. In this retrospective study, outcome and complications of PD using rigid catheter were evaluated in 113 critically ill children admitted in PICU of a tertiary care hospital from 2014 to 2019. The most common causes for AKI were sepsis (39.8%), dengue infection (16.8%), and hemolytic uremic syndrome (13.2%). In 113 patients, 122 PD catheters were inserted, and the median duration of PD was 60 (IQR: 36–89) hours. At the initiation of PD, 64 (56.6%) patients were critically ill requiring mechanical ventilation and inotropes, 26 (23%) had disseminated intravascular coagulation, and 42 (37%) had multiorgan dysfunction syndrome. PD was effective and there was a significant improvement in urea and creatinine, and one-third patients (n = 38; 33.6%) had complete renal recovery at the end of PD. Total complications were seen in 67% children but majority of them were metabolic (39.8%). Total catheter related complications were seen in 21.2% and peritonitis was seen in 4.4%. Catheter removal due to complications was required in 8.8% children. Overall, among children on PD, 53.7% survived. Acute PD with rigid catheters can be performed bedside in absence of soft catheters and significant clearance can be obtained without major life-threatening complications.

Peritoneal dialysis in critically ill children in resource-limited setting: A prospective cohort study

2020 ◽  
pp. 089686082097589
Author(s):  
Pallavi Choudhary ◽  
Virendra Kumar ◽  
Abhijeet Saha ◽  
Archana Thakur
Keyword(s):  
Mechanical Ventilation ◽  
Peritoneal Dialysis ◽  
Renal Impairment ◽  
Critically Ill ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Renal Outcome ◽  
Severe Dengue ◽  
Critically Ill Children

Background: Peritoneal dialysis (PD) is easily available and simple lifesaving procedure in children with renal impairment. There is paucity of reports on efficacy of PD in critically ill children in presence of shock and those requiring mechanical ventilation. Methods: In this prospective observational study, efficacy and outcome of PD were evaluated in 50 critically ill children aged 1 month to 14 years admitted in pediatric intensive care unit of a tertiary care teaching hospital in India. Results: Indication of PD was acute kidney injury (AKI) in 66% of patients followed by chronic kidney disease with acute deterioration due to infectious complications in 34%. Bacterial sepsis was the most common cause of AKI (22%), others being malaria (14%) and severe dengue (12%). At initiation of PD, 26% of patients were in shock and 46% were mechanically ventilated. PD was effective and improvement in pH, bicarbonate, and lactate started within hours, with consistent improvement in estimated glomerular filtration rate by 24 h, which continued till the end of procedure, including the subgroup of patients with shock and mechanical ventilation. Total complications were seen in 14% and of which peritonitis was present in 4.0% of patients. Mortality was seen in 14% (7/50) of patients. Shock at initiation of PD (odds ratio (OR), 5.03; 95% confidence interval (CI), 0.95–26.69; p < 0.04) and requirement of mechanical ventilation (OR, 9.17; 95% CI, 1.01–83.10; p < 0.02) were associated with mortality. Conclusions: Acute PD in critically ill children with renal impairment is a lifesaving procedure. Treatment of shock with resuscitative measures and respiratory failure with mechanical ventilation, along with PD, resulted in favorable renal outcome.

scholarly journals Paediatric RIFLE and AKIN Classification for Detection and Outcome of Acute Kidney Injury in Critically Sick Children. Which is Better? A Prospective Cohort Study

2018 ◽  
Vol 38 (1) ◽  
pp. 31-37
Author(s):  
Pareshkumar A Thakkar ◽  
Neha Pandey ◽  
Kalpita S Shringarpure
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Study ◽  
Critically Ill ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
Schwartz Formula ◽  
Sick Children

Introduction: Acute Kidney Injury (AKI) is becoming increasingly common in both developed and developing countries with significant morbidity and mortality. However, the precise incidence of AKI in children is not well known due to lack of uniformity in various definitions of AKI. This study was carried out to compare incidence of AKI using two different definitions-pRIFLE and AKIN.Material and Methods: This was a prospective cohort study conducted in the paediatric ICU of a tertiary care government hospital attached to a Medical College of Central Gujarat, India. Total 115 critically ill paediatric patients aged one month to 12 years were included in the study. Serum Creatinine (SCr) levels were tested and Glomerular filtration rate (GFR) was calculated using the Schwartz formula at 0, 6, 12, 24 and 48 hours of admission. Patients were assessed for AKI using AKIN and pRIFLE classification.Results: Incidence of AKI was 80% and 66.9% in critically ill children, as classified by pRIFLE and AKIN classification respectively. Paediatric RIFLE labelled 15 more patients as AKI which were classified as non-AKI by AKIN criteria. There was moderate agreement in between the two classifications to diagnose stages of AKI (Kappa 0.474, CI- 0.359 to 0.589). With increasing grades of AKI, mortality was higher using pRIFLE staging; unlike the AKIN staging wherein this was not observed.Conclusion: The pRIFLE criteria detects a greater number of cases of AKI compared to AKIN criteria. Based on severity staging, pRIFLE is more consistent with adverse outcome of patients with AKI compared to AKIN classification. Overall mortality is significant high in patients with AKI compared to patients without AKI using any of the classifications.  

scholarly journals Unusual clinical manifestations of dengue infection in children in a tertiary care hospital in northeast Thailand

2014 ◽  
Vol 8 (1) ◽  
pp. 97-103 ◽  
Author(s):  
Tanaporn Duangmala ◽  
Pagakrong Lumbiganon ◽  
Pope Kosalaraksa
Keyword(s):  
Acute Kidney Injury ◽  
Tertiary Care Hospital ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Kidney Injury ◽  
Neurological Symptoms ◽  
Care Hospital ◽  
Northeast Thailand ◽  
Altered Consciousness

AbstractBackground: Dengue virus infection has been a public health concern in Thailand. In the past decades, there has been recent interest concerning unusual clinical manifestations in both dengue fever (DF) and dengue hemorrhagic fever (DHF).Objective: We described the unusual clinical manifestations and outcomes of children with dengue admitted to a tertiary care hospital in northeast Thailand.Materials and Methods: A study was conducted on the 73 patients with serologically confirmed dengue infection admitted to Srinagarind Hospital, a tertiary care facility in northeast Thailand between January 2007 and August 2011.Results: Of the 73 children examined, 42 (57%) were boys and 31 were girls. Their age ranged from 8 months to 14 years (median 11 years). Nine patients developed neurological symptoms, 6 patients had altered consciousness, and 3 patients convulsion. Among 9 patients with neurological symptoms, 1 patient had acute kidney injury, 1 had hepatic failure, and 1 had kidney and liver involvement, mostly associated with fluid resuscitation or prolonged shock. Apart from neurological symptoms, one patient developed infection associated hemophagocytic syndrome and was treated with intravenous immunoglobulin. Two patients died from multiple organ failure, and 1 patient was brought back home in a moribund condition. The other patients recovered completely.Conclusion: Altered consciousness was the most commonly observed unusual neurological manifestation. Patients who did not develop acute kidney injury or liver failure had mild clinical courses and recovered from neurological symptoms without sequelae. Acute kidney injury was associated with fluid overload and/or prolonged shock. Careful fluid management and close monitoring for complications resulted in favorable outcomes.

scholarly journals Clinical profile and treatment outcome of acute kidney injury (AKI) in a tertiary care hospital

2018 ◽  
Vol 5 (3) ◽  
pp. 630
Author(s):  
P. Vijai Ananth ◽  
V. Prakash ◽  
D. Selvaraj ◽  
T. Mathimaraiselvan
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Tamil Nadu ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Multiple Infections ◽  
Care Hospital ◽  
Rifle Criteria ◽  
Study Population

Background: Acute Kidney Injury (AKI) is one of the major cause of in-hospital mortality rates globally. The current study was conducted to study the etiological profile, severity and management of   acute kidney injury.Methods: The study was a prospective observational study, conducted in the department general medicine, Dhanalakshmi Srinivasan Medical college and Hospital, Permabalur, Tamil Nadu. The study population included all the patients admitted to Intensive Care Unit (ICU) with acute Kidney injury (AKI) between January 2015 to December 2016. All the study participants were recruited to the study by convenient sampling. Descriptive analysis was carried out by frequency and proportion for categorical variables.Results: A total of 100 subjects were included. Participants were almost uniformly distributed in each of a decadal age group till above 60 years. Males (57%) were slightly higher than females (43%). Oliguria was present in 88% of the study population. The most common etiology was acute diarrhoeal disease (44%), followed by multiple infections in 12% and Sepsis in 10% of the subjects. As per RIFLE criteria 46% participants were at risk, 26.0% had injury, 28% had failure. All at risk people were treated conservatively, among injury category, 38.5% were treated by haemodialysis and 3.84% by peritoneal dialysis. In failure group, 60.71% and 3.57% were treated by haemodialysis and peritoneal dialysis respectively.Conclusions: Acute kidney Injury (AKI) can be a consequence of varied aetiologies and all the age groups and both the genders at risk of developing it. RIFLE criteria may be a useful tool in guiding the management.

scholarly journals Renal angina index predicts fluid overload in critically ill children: an observational cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Stephen M. Gorga ◽  
Erin F. Carlton ◽  
Joseph G. Kohne ◽  
Ryan P. Barbaro ◽  
Rajit K. Basu
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Fluid Overload ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Poor Outcomes ◽  
Renal Angina Index ◽  
Renal Angina

Abstract Background Fluid overload and acute kidney injury are common and associated with poor outcomes among critically ill children. The prodrome of renal angina stratifies patients by risk for severe acute kidney injury, but the predictive discrimination for fluid overload is unknown. Methods Post-hoc analysis of patients admitted to a tertiary care pediatric intensive care unit (PICU). The primary outcome was the performance of renal angina fulfillment on day of ICU admission to predict fluid overload ≥15% on Day 3. Results 77/139 children (55%) fulfilled renal angina (RA+). After adjusting for covariates, RA+ was associated with increased odds of fluid overload on Day 3 (adjusted odds ratio (aOR) 5.1, 95% CI 1.23–21.2, p = 0.025, versus RA-). RA- resulted in a 90% negative predictive value for fluid overload on Day 3. Median fluid overload was significantly higher in RA+ patients with severe acute kidney injury compared to RA+ patients without severe acute kidney injury (% fluid overload on Day 3: 8.8% vs. 0.73%, p = 0.002). Conclusion Among critically ill children, fulfillment of renal angina was associated with increased odds of fluid overload versus the absence of renal angina and a higher fluid overload among patients who developed acute kidney injury. Renal angina directed risk classification may identify patients at highest risk for fluid accumulation. Expanded study in larger populations is warranted.

OR007: Nutrition Support Guidelines in Critically Ill Children with Acute Kidney Injury

2015 ◽  
Vol 34 ◽  
pp. S2
Author(s):  
J.C. Silva ◽  
U.G. Kyle ◽  
M. Treviño ◽  
J.L. Lusk ◽  
G. Dardon ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Nutrition Support ◽  
Critically Ill Children ◽  
Support Guidelines

scholarly journals Urinary CXCL10 is Associated with Acute Kidney Injury and Sepsis, and Predicts Mortality in Critically Ill Children

2020 ◽  
Author(s):  
Hui Huang ◽  
Huiting Zhou ◽  
Wenwen Wang ◽  
Xiaomei Dai ◽  
Wenjing Li ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Inflammatory Mediator ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Surviving Sepsis Campaign ◽  
Predictive Values ◽  
Specific Setting ◽  
Potential Indicator

Abstract Background: Acute kidney injury (AKI) biomarkers are often susceptible to confounding factors, limiting their utility as a specific biomarker, in the prediction of AKI, especially in heterogeneous population. The urinary CXC motif chemokine 10 (uCXCL10), as an inflammatory mediator, has been proposed to be a biomarker for AKI in a specific setting. Whether uCXCL10 is associated with AKI and predicts AKI in critically ill patients remains unclear. The aims of the study were to investigate clinical variables potentially associated with uCXCL10 levels and determine the associations of uCXCL10 with AKI, sepsis and PICU mortality in critically ill children, as well as its predictive values of aforementioned issues. Methods: Urinary CXCL10 levels were serially measured in a heterogeneous group of children during the first week after pediatric intensive care unit (PICU) admission. AKI diagnosis was based on the criteria of Kidney Disease: Improving Global Outcomes with serum creatinine and urine output. Sepsis was diagnosed according to surviving sepsis campaign international guidelines for children. Mortality was defined as all-cause death occurring during the PICU stay.Results: Among 342 critically ill children, 52 (15.2%) developed AKI during the first week after PICU admission, and 132 (38.6%) were diagnosed as sepsis and 30 (12.3%) died during PICU stay. Both the initial and peak values of uCXCL10 remained independently associated with AKI with adjusted odds ratios (AORs) of 1.791 (P = 0.010) and 2.002 (P = 0.002), sepsis with AORs of 1.679 (P = 0.003) and 1.752 (P = 0.002), septic AKI with AORs of 3.281 (P <0.001) and 3.172 (P <0.001), and PICU mortality with AORs of 2.779 (P = 0.001) and 3.965 (P <0.001), respectively. The AUCs of the initial uCXCL10 for predicting AKI, sepsis, septic AKI, and PICU mortality were 0.63 (0.53-0.72), 0.62 (0.56-0.68), 0.75 (0.64-0.87), and 0.77 (0.68-0.86), respectively. The AUCs for prediction by using peak uCXCL10 were as follows: AKI 0.65 (0.56-0.75), sepsis 0.63 (0.57-0.69), septic AKI 0.76 (0.65-0.87), and PICU mortality 0.84 (0.76-0.91).Conclusions: Urinary CXCL10 is independently associated with AKI and sepsis, and may be a potential indicator of septic AKI and PICU mortality in critically ill children.

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