title: Risk factors of acute renal failure in critically ill children: A prospective descriptive epidemiological study.
abstract: OBJECTIVE
  Acute renal failure is a serious condition in critically ill patients, but little literature is available on acute renal failure in critically ill children. The aim of the study was to determine incidence rate, identify risk factors, and describe the clinical outcome of acute renal failure in the pediatric intensive care unit (PICU).
  
  
  METHODS
  Prospective, descriptive study.
  
  
  METHODS
  A tertiary PICU.
  
  
  METHODS
  Patients were 1,047 consecutively admitted children over a 1-yr period.
  
  
  METHODS
  None.
  
  
  RESULTS
  Acute renal failure was defined as doubling of baseline serum creatinine. A comparison between patients with acute renal failure and without acute renal failure was carried out, and the risk factors playing a significant role in the manifestation of acute renal failure were analyzed. There were 985 cases included in the study, with the incidence rate of acute renal failure in PICU being 4.5%. The most common PICU admission diagnoses in acute renal failure cases were hemolytic uremic syndrome (18.2%), oncologic pathologies (18.2%), and cardiac surgery (11.4%). Significant risk factors for acute renal failure following multivariate analysis were thrombocytopenia (odds ratio, 6.3; 95% confidence interval, 2.5, 16.2), age >12 yrs (odds ratio, 4.9; 95% confidence interval, 1.9, 13), hypoxemia (odds ratio, 3.2; 95% confidence interval, 1.3, 8.0), hypotension (odds ratio, 3.0; 95% confidence interval, 1.2, 7.5), and coagulopathy (odds ratio, 2.7; 95% confidence interval, 1.3, 5.6). The mortality rate was estimated to be higher in patients with acute renal failure compared with patients without acute renal failure (29.6% vs. 2.3%, p < .001).
  
  
  CONCLUSIONS
  Although not frequent in the PICU, acute renal failure is associated with a significant increase in mortality. The risk factors of acute renal failure are multiple and are often present before PICU admission. A multiple-center study is planned with the intention to confirm these results.
authors.affiliation: Service of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, Canada.
authors.forename: Dennis
authors.initials: D
authors.lastname: Bailey
authors.forename: Véronique
authors.initials: V
authors.lastname: Phan
authors.forename: Catherine
authors.initials: C
authors.lastname: Litalien
authors.forename: Thierry
authors.initials: T
authors.lastname: Ducruet
authors.forename: Aicha
authors.initials: A
authors.lastname: Mérouani
authors.forename: Jacques
authors.initials: J
authors.lastname: Lacroix
authors.forename: France
authors.initials: F
authors.lastname: Gauvin
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000401:mortality; D000293:Adolescent; D000367:Age Factors; D001778:Blood Coagulation Disorders / Q000150:complications; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003404:Creatinine / Q000097:blood; D016638:Critical Illness; D005260:Female; D006463:Hemolytic-Uremic Syndrome; D006801:Humans; D007022:Hypotension / Q000150:complications; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia / Q000150:complications
chemical_list: D003404:Creatinine