Etiology and outcome of acute kidney injury in children.
The aim of this prospective, multicenter study was to define the etiology and clinical features of acute kidney injury (AKI) in a pediatric patient cohort and to determine prognostic factors. Pediatric-modified RIFLE (pRIFLE) criteria were used to classify AKI. The patient cohort comprised 472 pediatric patients (264 males, 208 females), of whom 32.6% were newborns (median age 3 days, range 1-24 days), and 67.4% were children aged >1 month (median 2.99 years, range 1 month-18 years). The most common medical conditions were prematurity (42.2%) and congenital heart disease (CHD, 11.7%) in newborns, and malignancy (12.9%) and CHD (12.3%) in children aged >1 month. Hypoxic/ischemic injury and sepsis were the leading causes of AKI in both age groups. Dialysis was performed in 30.3% of newborns and 33.6% of children aged >1 month. Mortality was higher in the newborns (42.6 vs. 27.9%; p < 0.005). Stepwise multiple regression analysis revealed the major independent risk factors to be mechanical ventilation [relative risk (RR) 17.31, 95% confidence interval (95% CI) 4.88-61.42], hypervolemia (RR 12.90, 95% CI 1.97-84.37), CHD (RR 9.85, 95% CI 2.08-46.60), and metabolic acidosis (RR 7.64, 95% CI 2.90-20.15) in newborns and mechanical ventilation (RR 8.73, 95% CI 3.95-19.29), hypoxia (RR 5.35, 95% CI 2.26-12.67), and intrinsic AKI (RR 4.91, 95% CI 2.04-11.78) in children aged >1 month.
Department of Pediatrics, Pediatric Nephrology and Rheumatology Unit, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, 06100, Turkey. aduzova@hacettepe.edu.tr
Ali
A
Duzova
Aysin
A
Bakkaloglu
Mukaddes
M
Kalyoncu
Hakan
H
Poyrazoglu
Ali
A
Delibas
Ozan
O
Ozkaya
Harun
H
Peru
Harika
H
Alpay
Oguz
O
Soylemezoglu
Ayfer
A
Gur-Guven
Mustafa
M
Bak
Zelal
Z
Bircan
Nurcan
N
Cengiz
Ipek
I
Akil
Birsin
B
Ozcakar
Nermin
N
Uncu
Aysun
A
Karabay-Bayazit
Ferah
F
Sonmez
D058186:Acute Kidney Injury / Q000401:mortality*; D002648:Child; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007668:Kidney; D008297:Male; D015999:Multivariate Analysis; D012121:Respiration, Artificial / Q000401:mortality; D012307:Risk Factors; D018805:Sepsis / Q000401:mortality; D016896:Treatment Outcome