Examination of patients with acute kidney injury in the pediatric intensive care unit

Abstract

Introduction: Acute kidney injury (AKI), has negatively impacting the mortality and morbidity of patients in pediaric intensive care units. We aimed to investigate AKI causes, risk factors and factors affecting survival in children while being monitored in the pediatric intensive care unit (PICU). Material and methods: 328 patients, who were followed up in the PICU between January 2018 and March 2021 for various reasons, were examined retrospectively. 43 (13,1%) patients who diagnosed with AKI without prior chronic kidney injury were included in the study. Results of demographic data, primary diagnosis, AKI causes, risk factors and Pediatric Risk of Mortality (PRISM III) scores of surviving and deceased were compared. Results: 15 of AKI patients (34,9%) were girls. The mean age was 6.18 ± 5.61 (median: 5) years. On the first day of hospitalization in PICU, PRISM III scores were 19.48 ± 9.65 (median: 19). Acute lymphoblastic leukemia was the most common primary disease with 7 patients (16,2%). Median PICU length of stay was 10 days. We found that 30 (89,7%) patients developed AKI while being followed up with a mechanical ventilator and 28 (65,1%) of these patients used nephrotoxic drugs before AKI developed. It was found that 17 (39,5%) cases developed oliguria and/or anuria, and 36 (83,7%) patients developed multiple organ failure. Dialysis treatment was applied to 8 (18,6%) patients and continuous dialysis treatment methods were preferred in all of them. Median duration of dialysis time was 3,5 days. 28 (65,1%) patients died. PRISM scores, sepsis and dialysis requirement were found to be statistically significantly higher in deceased than surviving patients (respectively p= 0.001, p=0.001, p=0.001). Conclusions: Despite technological advances, AKI is an important cause of mortality and morbidity in critically ill patients. PRISM scoring and the presence of sepsis can be considered as an important determinant in predicting mortality and acting early for the dialysis decision.