Frequency and Outcome of Acute Kidney Injury (Aki) among Children Admitted to Pediatric ICU, Mayo Hospital, Lahore
DOI:
https://doi.org/10.47489/szmc.v39i4.796Keywords:
Acute kidney injury, Pediatric intensive care unit, Mechanical ventilation, renal dysfunctionAbstract
Background: Acute Kidney Injury is a frequent illness, commonly observed in children admitted to intensive care units. Risk of AKI increases with requirement of mechanical ventilation, use of nephrotoxic drugs, need of ionotropic support. The children developing renal failure have higher risk of mortality and morbidity.
Objective: This study was conducted to determine the frequency and outcomes of AKI among critically ill children.
Method: It is a descriptive observational study, and it was done at PICU of Pediatric Medicine Department, Mayo Hospital Lahore in 6 months from October 13, 2023 – April 13, 2024. It was started after approval from Institutional Review Board. 240 children aged 1 month to 12 years of either gender, were enrolled considering 95% confidence level, 5% absolute precision and prevalence of AKI as 19.28%. Children with underlying congenital renal disorder, metabolic disorder or birth defect were excluded. AKI was diagnosed by considering KDIGO classification which included measurement of urine output and serum creatinine (1.5cc serum sample was sent for biochemistry). Outcomes were measured as mortality (death within 7 days of hospital stay), duration of stay or complete recovery of the patient. Data analysis was done using SPSS; the test applied for AKI and outcome was chi-square, while other variables were analysed using t-test or Mann-Whitney U test as per normality of data.
Results: The frequency of AKI was 17.1% (41) in critically ill children. Mechanical ventilation was required in 29.6% (71) patients and exposure to nephrotoxic drugs was reported in 33.3% (80) cases. Mechanical ventilation was independently related to the development of AKI (45.1% vs. 5.3%, p < 0.001). Nephrotoxic drug exposure was also a risk factor, with 43.8% (35) of exposed patients developing AKI compared to 18.1% (29) in the non-exposed group (p = 0.002). Death was significantly high (26.7%), and an alarming 85.9% of ventilated patients died. An all-cause mortality was observed in PICU, nephrotoxic drugs’ exposure being most significant cause. (43.8% vs. 18.1%, p < 0.001).
Conclusion: AKI is a frequent and severe illness observed in critically ill children, and is associated with multiple factors, most frequent being mechanical ventilation, use of nephrotoxic drugs, and higher mortality. An all-cause mortality was considered, AKI being the significant one.
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