Incidence, risk factors, clinical profile, and determinants (affecting outcome) of new onset acute kidney injury developing in critically Illpatients in pediatric intensive care unit of a tertiary hospital in middle India

Background. Acute kidney injury (AKI) is a common serious problem affecting critically ill patients in intensive care unit (ICU). It increases their morbidity, mortality, length of ICU stay, and long-term risk of chronic kidney disease (CKD). Methods. A retrospective study was carried out in a tertiary hospital in Jordan. Medical records of patients admitted to the medical ICU between 2013 and 2015 were reviewed. We aimed to identify the incidence, risk factors, and outcomes of AKI. Acute kidney injury network (AKIN) classification was used to define and stage AKI. Results. 2530 patients were admitted to medical ICU, and the incidence of AKI was 31.6%, mainly in stage 1 (59.4%). In multivariate analysis, increasing age (odds ratio (OR) = 1.2 (95% CI 1.1–1.3), P = 0.0001) and higher APACHE II score (OR = 1.5 (95% CI 1.2–1.7), P = 0.001) were predictors of AKI, with 20.4% of patients started on hemodialysis. At the time of discharge, 58% of patients with AKI died compared to 51.3% of patients without AKI (P = 0.05). 88% of patients with AKIN 3 died by the time of discharge compared to patients with AKIN 2 and 1 (75.3% and 61.2% respectively, P = 0.001). Conclusion. AKI is common in ICU patients, and it increases mortality and morbidity. Close attention for earlier detection and addressing risk factors for AKI is needed to decrease incidence, complications, and mortality.

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A Study of Acute Kidney Injury in a Tertiary Care Pediatric Intensive Care Unit

Journal of Pediatric Intensive Care ◽

10.1055/s-0040-1716577 ◽

2020 ◽

Author(s):

Akanksha C. Parikh ◽

Milind S. Tullu

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Hospital Stay ◽

Pediatric Intensive Care Unit ◽

Tertiary Care ◽

Kidney Injury ◽

Pediatric Intensive Care ◽

Critically Ill Children

AbstractThe objective of this study was to calculate the incidence, severity, and risk factors for acute kidney injury (AKI) in a tertiary care pediatric intensive care unit (PICU). Also, to assess the impact of AKI and its varying severity on mortality and length of hospital and PICU stays. A prospective observational study was performed in children between 1 month and 12 years of age admitted to the PICU between July 1, 2013, and July 31, 2014 (13 months). The change in creatinine clearance was considered to diagnose and stage AKI according to pediatric risk, injury, failure, loss, and end-stage renal disease criteria. The risk factors for AKI and its impact on PICU stay, hospital stay, and mortality were evaluated. Of the total 220 patients enrolled in the study, 161 (73.2%) developed AKI, and 59 cases without AKI served as the “no AKI” (control) group. Majority (57.1%) of children with AKI had Failure grade of AKI, whereas 26.1% had Risk grade and 16.8% had Injury grade of AKI. Infancy (p = 0.000), hypovolemia (p = 0.005), shock (p = 0.008), and sepsis (p = 0.022) were found to be significant risk factors for AKI. Mortality, PICU stay, and hospital stay were comparable in children with and without AKI as well as between the various grades of renal injury (i.e., Failure, Risk, and Injury). An exceedingly high incidence of AKI, especially of the severe Failure grade was observed in critically ill children. Infancy and frequent PICU occurrences such as sepsis, hypovolemia, and shock predisposed to AKI.

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Frequency of and Risk Factors for Acute Kidney Injury Associated With Vancomycin Use in the Pediatric Intensive Care Unit

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-21.6.486 ◽

2016 ◽

Vol 21 (6) ◽

pp. 486-493 ◽

Cited By ~ 3

Author(s):

Sarah Bonazza ◽

Lauren C. Bresee ◽

Timothy Kraft ◽

B. Catherine Ross ◽

Deonne Dersch-Mills

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Kidney Injury ◽

Pediatric Intensive Care ◽

Retrospective Chart Review ◽

Primary Objective ◽

Vancomycin Trough

BACKGROUND: Published information evaluating frequency of and risk factors for vancomycin-induced acute kidney injury (AKI) in the pediatric intensive care unit (PICU) population is conflicting. OBJECTIVES: The primary objective was to describe the proportion of our PICU patients who developed AKI with intravenous (IV) vancomycin. The secondary objective was to describe the associated potential risk factors. METHODS: Pediatric patients (0–18 years) who received their first IV vancomycin dose in the PICU were evaluated in this retrospective chart review. AKI was defined based on Pediatric-Modified RIFLE (pRIFLE) criteria. Patient demographics, vancomycin trough concentrations, concomitant nephrotoxins, and estimated creatinine clearance changes were analyzed. RESULTS: Of 265 patients included, the primary outcome of AKI (defined by meeting any pRIFLE criteria) occurred in 62 (23.4%) patients (48 category R, 11 category I, 3 category F). Patients who received vancomycin treatment for = 5 days were more likely to develop AKI (unadjusted odds ratio [uOR]: 2.52; 95% confidence interval [CI]: 1.11–5.73), as were patients with a maximum vancomycin trough level = 20 mg/L (OR: 2.99; 95% CI: 1.54–5.78) and patients on 1 (uOR: 2.29; 95% CI: 1.12–4.66) or more concurrent nephrotoxin (uOR: 3.11; 95% CI: 1.43–6.77). Among nephrotoxins, patients receiving furosemide concomitantly with vancomycin were more likely to develop AKI (uOR: 3.47; 95% CI: 1.92–6.27). After adjustment, only furosemide was a significant predictor of risk of AKI/AKI (adjusted OR: 3.52; 95% CI: 1.88–6.62). The study was limited by its retrospective and observational design, and confounding variables. CONCLUSIONS: Patients who were receiving vancomycin with concurrent furosemide were at highest risk of developing AKI.

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Study of clinical profile, risk factors of acute kidney injury in children admitted in pediatric intensive care unit at tertiary health care centre

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20203159 ◽

2020 ◽

Vol 7 (8) ◽

pp. 1665

Author(s):

Harsha S. ◽

Gonesh N. Mevundi

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

General Hospital ◽

Pediatric Intensive Care Unit ◽

Significant Risk ◽

Kidney Injury ◽

Pediatric Intensive Care ◽

Clinical Profile

Background: Acute kidney injury (AKI) is an important condition in hospitalized patients, associated with adverse short- and long-term outcomes. Objective of this study was to determine the clinical profile of acute kidney injury in pediatric ICU (Basaveshwar Teaching and General Hospital, Sangameshwar Hospital, Kalaburagi).Methods: This study was conducted in all patients within the age group of 1 month to 18 years admitted in the PICU (pediatric intensive care unit) at Basaveshwar teaching and General hospital and Sangameshwar hospital attached to Mahadevappa Rampure medical college during a period from December 2015 to May 2017.Results: Incidence of AKI was 6.9% in pediatric intensive care unit. The median age of boys and girls were 4.56±3.84 and 4.49±4.01 respectively. Hypotension and need for ventilation were significant risk factors for AKI (p<0.001). The median admission serum creatinine value in AKI patients was 2.91±2.48 mg/dL. In the present study, the median duration of PICU and Hospital stay was 9.98±7.27 in AKI group compared to7.41±5.62 days in non-AKI group (p<0.001).Conclusions: It was concluded that Incidence of AKI was 6.9% in pediatric intensive care unit. The mean and SD of age of boys and girls were 4.56±3.84 and 4.49±4.01 respectively. Hypotension and need for ventilation were significant risk factors for AKI.

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