Background Acute kidney injury (AKI) is an independent predictor of morbidity and mortality among critically ill children. However, epidemiological data in Asian paediatric populations remain scarce.
Objectives We presented the result of the interim analysis of an ongoing prospective cohort study on the epidemiology of AKI and electrolytes disturbances and their potential relationships with nephrotoxic medications (E-AKI-Drug) in a newly established paediatric intensive care unit (PICU).
Methods We enrolled all children aged 1 month to 18 years old admitted to the PICU of our hospital after June 2020. Those with pre-existing chronic kidney disease, impaired renal function for ≥3 months, immediate post-renal transplant and short stay in PICU <1 day with no blood taking would be excluded. Children without a urinary catheter would be excluded from urine calculation. AKI would be defined using the KDIGO criteria. The medication records from 14 days prior to PICU admission to PICU discharge would be retrieved and reviewed by an independent pharmacist. The results of the initial 4 months of data collected would be presented.
Results Altogether 62 patients with 63 episodes of admission were included for the analysis. Of these, 58.7% were male and the median (25th, 75th percentile) age was 6.1 (1.6, 12.7) years old. 49.2% of patients had a diagnosis of malignancy, 9.5% of them received bone marrow transplantation and 31.7% of patients were admitted post-operation. The overall incidence of AKI during PICU stay was 55.6% using either the creatinine-based or urine output-based criteria (stage 1: 20.6%, stage 2: 15.9% and stage 3: 19.0%). Most patients experienced AKI on Day 1 of PICU admission using the creatine-based criteria (figure 1). Children with AKI had more types of electrolytes disturbances (5 types vs 3 types, p<0.01). Urine output and fluid overload on Day 1 of PICU admission were not significantly different between those with and without AKI. Risk factors for developing AKI during PICU admission included recipient of bone marrow transplantation (relative risk [RR with 95% confidence interval]: 1.58 [1.03, 2.44]), requirement of inotropic support (RR: 1.74 [1.17, 2.59]) and non-invasive ventilation (RR: 1.76 [1.22, 2.55]), and a higher number of nephrotoxic medication exposure (RR: 1.20 [1.04, 1.38]) (table 1). 6.3% of patients required continuous renal replacement therapy. The overall mortality was 4.8%. Patients with AKI had a longer PICU length of stay (4 vs 3 days, p=0.004) and hospitalization duration (23 vs 11 days, p=0.036) and a lower estimated glomerular filtration rate (eGFR) upon PICU discharge (136.1 vs 174.1 ml/min/1.73 m2, p=0.012). Altogether 7.9% of patient were discharged from PICU with impaired renal function and 3.2% of them were dialysis-dependent.
Conclusions AKI was commonly encountered among critically ill children. History of bone marrow transplantation, requirement of inotropic and non-invasive ventilatory support, and higher number of nephrotoxic medications were risk factors for AKI development. Those who had AKI were associated with a higher mortality, longer PICU and hospital stay and a lower eGFR on PICU discharge. A significant proportion of children with AKI were discharged with impaired renal function that warranted a long-term follow-up.
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