Risk factors and outcome of acute kidney injury in children admitted to the pediatric intensive care unit

Background: Acute kidney injury (AKI) is a common and serious complication in children admitted to the Pediatric Intensive Care Unit (PICU). The primary objective of our study was to estimate the incidence of AKI in children admitted to PICU. Secondary objective was to study the etiology ,short term outcome and determine the predictors of fatality in children with AKI. Methods: This was a prospective, cross sectional study conducted in children aged 1month to 18 years in the Pediatric Intensive Care Unit of Amrita Institute Of Medical Science, Kochi from Nov 2015 to Oct 2017 based on Acute Kidney Injury Network Criteria(AKIN). Results: The incidence of AKI was 18% .59.3% of the AKI patients were ≤5year of age. Most common cause for AKI was due to infections(87%) mainly sepsis(42.7%). 88.9% children had pre renal, 9.3% had renal and 1.9% had post renal type of AKI.40.7% were in stage 1,13% in stage2 and 46.3% in stage 3 based on AKIN criteria. 42.6% had complete recovery, 16.7% had partial recovery and death in 40.7% patients. 25.9% of AKI patients required dialysis. Children with AKI (7.85 ± 4.917) had prolonged PICU stay when compared with Non AKI group (4.28 ± 2.920 days) with p value: <0.001. AKI was associated with increased mortality (40.7%, p < 0.001). 43.8% of children with prerenal AKI and 77.3% children in stage 3 had the highest mortality (P value <0.001). Predictors of fatality were presence of Hypertension and the need for Ventilation (P-value < 0.05). Conclusions: It was concluded that the incidence of AKI was 18%. Most common etiology was Sepsis (42.5%) Children with AKI had prolonged PICU stay. AKI was associated with increased mortality (p < 0.001).Need for Ventilation was found to be a significant risk factor for developing AKI (p <0.001).Predictors of fatality were Hypertension and the need for Ventilation.