Evaluation of the prevalence and factors associated with acute kidney injury in a pediatric intensive care unit

Louzada, Cibelle Ferreira; Ferreira, Alexandre Rodrigues

doi:10.1016/j.jped.2020.08.003

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Sumário

Original articles • J. Pediatr. (Rio J.) 97 (4) • Jul-Aug 2021 • https://doi.org/10.1016/j.jped.2020.08.003 copy

Evaluation of the prevalence and factors associated with acute kidney injury in a pediatric intensive care unit^☆ ☆ Study conducted at Universidade Federal de Minas Gerais, Hospital das Clínicas, Belo Horizonte, MG, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To assess the prevalence of acute kidney injury in pediatric intensive care unit according to diagnostic criteria - pediatric risk, injury, failure, loss, end-stage renal disease, Acute Kidney Injury Network and Acute Kidney Injury Work Group, or Kidney Disease: Improving Global Outcomes -, and determining factors associated with acute kidney injury as well as its outcome.

Methodology

This was a cross-sectional monocentric observational study, including patients aged between 29 days and 17 years who were admitted to the pediatric intensive care unit between January 1, 2012 and December 31, 2016. To evaluate the association between the study variables and acute kidney injury, the log-binomial generalized univariate and multivariate linear models were adjusted.

Results

The study included 1131 patients, with prevalence of acute kidney injury according to the Acute Kidney Injury Network and Kidney Disease: Improving Global Outcomes criteria of 12.6% and of 12.9% according to the pediatric risk, injury, failure, loss, end-stage renal disease. In the multivariate analysis of older children (PR 1.007, 95% CI: 1.005-1.009), sepsis (PR 1.641, 95% CI: 1.128-2.387), demand for ventilatory support (PR 1.547, 95% CI: 1.095-2.186), and use of vasoactive amines (PR 2.298, 95% CI: 1.681-3.142) constituted factors associated with statistical significance to the development of acute kidney injury. The mortality rate among those with acute kidney injury was 28.7%.

Conclusion

Older children, diagnosis of sepsis, demand for ventilatory support, and use of vasoactive amines were correlated with a higher risk of developing acute kidney injury. The mortality associated with acute kidney injury was elevated; it is crucial that all measures that ensure adequate renal perfusion are taken for patients with risk factors, to avoid the installation of the disease.

Keywords
Acute kidney injury; pRIFLE; AKIN; KDIGO; Critical care; Intensive care

Variables	With AKI n (%) n = 143	Without AKI n (%) n = 988	p-value
Age in months (median [Q1; Q3])	98.00 (17.00; 167.00)	41.00 (7.00; 113.00)	< 0.0001^c c Mann-Whitney.
Male gender	71 (11.7)	538 (88.3)	0.282^b
Diagnosis of chronic disease	122 (12.5)	851 (87.5)	0.792^b
Diagnosis of onco-hematological disease	25 (15.2)	140 (84.8)	0.294^b b Asymptotic Pearson's chi square.
PIM3 % (median [Q1; Q3])	2.5 (1.1; 7.6)	1.3 (0.5; 3.7)	< 0.0001^c c Mann-Whitney.
Patients N (%)
1. Clinician	93 (15.6)	502 (84.4)	0.001^b b Asymptotic Pearson's chi square.
2. Surgical	50 (9.3)	486 (90.7)
Tumor lysis	2 (7.1)	26 (92.9)	0.423^a a Pearson's exact chi-square.
Sepsis	109 (15.4)	597 (84.6)	< 0.0001^b b Asymptotic Pearson's chi square.
Use of nephrotoxic medication	113 (14.9)	643 (85.1)	0.001^b b Asymptotic Pearson's chi square.
Nephrotoxic medication (groups)
0	30 (8.0)	345 (92.0)	< 0.0001^b b Asymptotic Pearson's chi square.
1	57 (11.7)	433 (88.3)
2	42 (19.50)	174 (80.6)
3 or more groups	14 (26.9)	380 (73.1)
Use of vasoactive drugs	72 (25.8)	207 (74.2)	< 0.0001^c c Mann-Whitney.
Vasoactive drugs
1. Vasopressors	23 (19.7)	93 (80.3)	0.004^a a Pearson's exact chi-square.
2. Inotropics	6 (14.6)	36 (85.4)
3. Both	43 (35.5)	78 (64.5)
MV	97 (17.6)	453 (82.4)	< 0.0001^b b Asymptotic Pearson's chi square.
MV time in days (median [Q1; Q3])	6.00 (2.00; 13.00)	3.00 (2.00; 7.00)	< 0.0001^c c Mann-Whitney.
Length of hospital stay in days (median [Q1; Q3])	6.00 (3.00; 13.00)	3.00 (2.00; 7.00)	< 0.0001^c c Mann-Whitney.
Death	41 (53.9)	35 (46.1)	< 0.0001^b b Asymptotic Pearson's chi square.

Variables	With AKI n (%) n = 143	Without AKI n (%) n = 988	Total (%)	PR	CI 95% PR	p-value
Age in months (median [Q1; Q3])	98.00 (17.00; 167.00)	41.00 (7.00; 113.00)		1.006	1.003; 1.008	< 0.0001
Gender
Female	72 (13.8)	450 (86.2)	522 (100.0)	1.183	0.871; 1.607	0.282
Male	71 (11.7)	538 (88.3)	609 (100.0)	1
Diagnosis of chronic disease
1. Yes	122 (12.5)	851 (87.5)	973 (100.0)	1	0.689; 1.632	0.791
2. No	21 (13.3)	137 (86.7)	159 (100.0)	1.060
Diagnosis of onco-hematological disease
1. Yes	25 (15.2)	140 (84.8)	165 (100.0)	1.240	0.833; 1.848	0.290
2. No	118 (12.2)	848 (87.8)	966 (100.0)	1
PIM3% (median [Q1; Q3])	2.5 (1.1; 7.6)	1.3 (0.5; 3.7)		7.442	2.198; 25.192	0.001
Patients N (%)
1. Clinician	93 (15.6)	502 (84.4)	595 (100.0)	1.676	1.213; 2.315	0.002
2. Surgical	50 (9.3)	486 (90.7)	536 (100.0)	1
Sepsis
1.Yes	109 (15.4)	597 (84.6)	706 (100.0)	1.930	1.339; 2.782	< 0.0001
2.No	34 (8.0)	391 (92.0)	425 (100.0)	1
Use of nephrotoxic medication
1. Yes	113 (14.9)	643 (85.1)	756 (100.0)	1.868	1.274; 2.740	0.001
2. No	30 (8.0)	345 (92.0)	375 (100.0)	1
Nephrotoxic medication (groups)
0	30 (8.0)	345 (92.0)	375 (100.0)	1	0.954; 2.216	0.081
1	57 (11.6)	433 (88.4)	490 (100.0)	1.454	1.569; 3.765	< 0.001
2	42 (19.4)	174 (80.6)	216 (100.0)	2.431	1.996; 6.137	< 0.0001
3 or more groups	14 (28.0)	36 (72.0)	50 (100.0)	3.500
Use of vasoactive drugs
1. Yes	72 (25.8)	207 (74.2)	279 (100.0)	3.097	2.297; 4.174	< 0.0001
2. No	71 (8.3)	781 (91.7)	852 (100.0)	1
Vasoactive drugs
1. Vasopressors	23 (19.8)	93 (80.2)	116 (100.0)	1
2. Inotropics	6 (14.3)	36 (85.7)	42 (100.0)	1.388	0.607; 3.171	0.437
3. Both	43 (35.5)	78 (64.5)	121 (100.0)	2.488	1.142; 5.420	0.022
MV
1. Yes	97 (17.6)	453 (82.4)	550 (100.0)	2.228	1.600; 3.101	< 0.0001
2. No	46 (7.9)	535 (92.1)	581 (100.0)	1
MV time in days (median [Q1; Q3])	6.00 (2.00 13.00)	3.00 (2.00; 7.00)		1.003	0.997; 1.009	0.368
Length of hospital stay in days (median [Q1; Q3])	6.00 (3.00 13.00)	3.00 (2.00; 7.00)		1.004	1.000; 1.008	0.068

Variables	PR	CI 95% of PR	p-value
Age	1.007	1.005; 1.009	< 0.0001
Sepsis	1.641	1.128; 2.387	0.010
Use of vasoactive drugs	2.298	1.681; 3.142	< 0.0001
MV	1.547	1.095; 2.186	0.013

Sociedade Brasileira de Pediatria Av. Carlos Gomes, 328 cj. 304, 90480-000 Porto Alegre RS Brazil, Tel.: +55 51 3328-9520 - Porto Alegre - RS - Brazil
E-mail: jped@jped.com.br

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[1] * Corresponding author.E-mail: cibelle.louzada@ufop.edu.br (C.F. Louzada).

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Evaluation of the prevalence and factors associated with acute kidney injury in a pediatric intensive care unit☆ ☆ Study conducted at Universidade Federal de Minas Gerais, Hospital das Clínicas, Belo Horizonte, MG, Brazil.

Abstract

Objective

Methodology

Results

Conclusion

Evaluation of the prevalence and factors associated with acute kidney injury in a pediatric intensive care unit^☆ ☆ Study conducted at Universidade Federal de Minas Gerais, Hospital das Clínicas, Belo Horizonte, MG, Brazil.