scholarly journals Risk factors for acute kidney injury in a pediatric intensive care unit: a retrospective cohort study

Medwave ◽  
2017 ◽  
Vol 17 (03) ◽  
pp. e6940-e6940 ◽  
Author(s):  
Lina María Serna-Higuita ◽  
John Fredy Nieto-Ríos ◽  
Jorge Eduardo Contreras-Saldarriaga ◽  
Juan Felipe Escobar-Cataño ◽  
Luz Adriana Gómez-Ramírez ◽  
...  
2016 ◽  
Vol 20 (9) ◽  
pp. 526-529 ◽  
Author(s):  
Sheetal Gupta ◽  
Ghanshyam Sengar ◽  
Praveen K. Meti ◽  
Anil Lahoti ◽  
Mukesh Beniwal ◽  
...  

Author(s):  
Akanksha C. Parikh ◽  
Milind S. Tullu

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.


2016 ◽  
Vol 21 (6) ◽  
pp. 486-493 ◽  
Author(s):  
Sarah Bonazza ◽  
Lauren C. Bresee ◽  
Timothy Kraft ◽  
B. Catherine Ross ◽  
Deonne Dersch-Mills

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.


2017 ◽  
Vol 52 (2) ◽  
pp. 133-139 ◽  
Author(s):  
Heidi L. Banasch ◽  
Deonne A. Dersch-Mills ◽  
Leah L. Boulter ◽  
Elaine Gilfoyle

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