Risk factors and prognostic factors of acute kidney injury in children: A retrospective study between 2003 and 2013

Abstract

Recent report on epidemiology of acute kidney injury (AKI) is lacking for Chinese children. We aimed to investigate the risk factors for stage and prognostic factors for renal recovery in hospitalized children. Pediatric patients (≤18 years old) admitted during 2003 to 2013 were enrolled in this study. AKI was defined and staged using Kidney Disease Improving Global Outcomes (KDIGO) criteria. Logistic regression analysis was performed to determine the risk factors and prognostic factors. The morbidity of pediatric AKI was 0.31% (205/65 237). There were 45 (22.0%) cases in stage III, 30 (14.6%) cases in stage II and 130 (63.4%) cases in stage III. The majority of etiologies were intrinsic renal defects (85.4%). Age, weight, vomit, etiology, blood urea nitrogen (BUN) at admission and several blood gas measurements were associated with AKI stage III. Age (OR=0.894; 95% CI, 0.832–0.962; P=0.003), vomit (OR=2.375; 95% CI, 1.058–5.333; P=0.036) and BUN at admission (OR=1.135; 95% CI, 1.085–1.187; P<0.001) were identified as independent risk factors for AKI stage III. After treatment, 172 (83.9%) patients achieved complete or partial recovery. The mortality was 3.9%. Variables were found as prognostic factors for renal recovery, such as age, stage, hospital stay, BUN at discharge, white blood cells, red blood cells, platelets (PLTs), blood pH and urine blood. Among them, AKI stage (stage III vs. stage I; OR, 6.506; 95% CI, 1.640–25.816; P=0.008), BUN at discharge (OR, 0.918; 95% CI, 0.856–0.984; P=0.016) and PLTs (OR, 1.007; 95% CI, 1.001–1.013; P=0.027) were identified as independent prognostic factors. AKI is still common in Chinese hospitalized children. Identified risk factors and prognostic factors provide guiding information for clinical management of AKI.

Keywords

epidemiology / acute kidney injury / children / risk factors / prognostic factors

References

[1] AskenaziDJ, FeigDI, GrahamNM, et al. . 3-5 year longitudinal follow-up of pediatric patients after acute renal failure. Kidney Int, 2006, 69(1): 184-189 PMID: 16374442

[2] KellumJA, LameireN. Diagnosis, evaluation, and management of acute kidney injury: A kdigo summary (part 1). Crit Care, 2013, 17(1): 204 PMCID: 4057151 PMID: 23394211

[3] SiewED, DavenportA. The growth of acute kidney injury: A rising tide or just closer attention to detail. Kidney Int, 2015, 87(1): 46-61 PMCID: 4281297 PMID: 25229340

[4] JenssenGR, HovlandE, BangstadHJ, et al. . The incidence and aetiology of acute kidney injury in children in Norway between 1999 and 2008. Acta Paediatr, 2014, 103(11): 1192-1197 PMCID: 4480659 PMID: 25039408

[5] OtukeshH, HoseiniR, HoomanN, et al. . Prognosis of acute renal failure in children. Pediatr Nephrol, 2006, 21(12): 1873-1878 PMID: 16960713

[6] GokcayG, EmreS, TanmanF, et al. . An epidemiological approach to acute renal failure in children. J Trop Pediatr, 1991, 37(4): 191-193 PMID: 1960778

[7] AkcayA, TurkmenK, LeeD, et al. . Update on the diagnosis and management of acute kidney injury. Int J Nephrol Renovasc Dis, 2010, 3: 129-140 PMCID: 3108768 PMID: 21694939

[8] BunchmanTE, McBrydeKD, MottesTE, et al. . Pediatric acute renal failure: Outcome by modality and disease. Pediatr Nephrol, 2001, 16(12): 1067-1071 PMID: 11793102

[9] SinhaR, NandiM, TullusK, et al. . Ten-year follow-up of children after acute renal failure from a developing country. Nephrol Dial Transplant, 2009, 24(3): 829-833 PMID: 18852189

[10] SutherlandSM, JiJ, SheikhiFH, et al. . AKI in hospitalized children: Epidemiology and clinical associations in a national cohort. Clin J Am Soc Nephrol, 2013, 8(10): 1661-1669 PMCID: 3789331 PMID: 23833312

[11] UchinoS, KellumJA, BellomoR, et al. . Acute renal failure in critically ill patients: A multinational, multicenter study. JAMA, 2005, 294(7): 813-818 PMID: 16106006

[12] BaileyD, PhanV, LitalienC, et al. . Risk factors of acute renal failure in critically ill children: A prospective descriptive epidemiological study. Pediatr Crit Care Med, 2007, 8(1): 29-35 PMID: 17251879

[13] BasuRK, DevarajanP, WongH, et al. . An update and review of acute kidney injury in pediatrics. Pediatr Crit Care Med, 2011, 12(3): 339-347 PMID: 21057358

[14] FortenberryJD, PadenML, GoldsteinSL. Acute kidney injury in children: An update on diagnosis and treatment. Pediatr Clin North Am, 2013, 60(3): 669-688 PMID: 23639662

[15] ChangJW, JengMJ, YangLY, et al. . The epidemiology and prognostic factors of mortality in critically ill children with acute kidney injury in Taiwan. Kidney Int, 2015, 87(3): 632-639 PMID: 25252027

[16] CaoY, YiZW, ZhangH, et al. . Etiology and outcomes of acute kidney injury in Chinese children: A prospective multicentre investigation. BMC Urol, 2013, 13: 41 PMCID: 3850083 PMID: 23964797

[17] YangF, ZhangL, WuH, et al. . Clinical analysis of cause, treatment and prognosis in acute kidney injury patients. PLoS One, 2014, 9(2): 85214

[18] ZouCC, ChenXY, ZhaoZY, et al. . Outcome of children with melamine-induced urolithiasis: Results of a two-year follow-up. Clin Toxicol (Phila), 2013, 51(6): 473-479

[19] HaldenwangP, TrampischM, SchlomicherM, et al. . Risk factors for acute kidney injury following ta-tavi or minimally invasive aortic valve replacement: Which procedure is less kidney damaging in elderly patients. Thorac Cardiovasc Surg, 2014, 62(6): 482-488 PMID: 25025889

[20] SoljancicA, RuizAL, ChandrashekarK, et al. . Protective role of testosterone in ischemia-reperfusion-induced acute kidney injury. Am J Physiol Regul Integr Comp Physiol, 2013, 304(11): R951-958 PMCID: 4074000 PMID: 23552495

[21] GavaAL, FreitasFP, MeyrellesSS, et al. . Genderdependent effects of aging on the kidney. Braz J Med Biol Res, 2011, 44(9): 905-913 PMID: 21956533

[22] Md RalibA M, NorMB. Acute kidney injury in a malaysian intensive care unit: Assessment of incidence, risk factors, and outcome. J Crit Care, 2015, 30(3): 636-642

[23] NgRR, ChewST, LiuW, et al. . Identification of modifiable risk factors for acute kidney injury after coronary artery bypass graft surgery in an Asian population. J Thorac Cardiovasc Surg, 2014, 147(4): 1356-1361 PMID: 24183907

[24] NaikBI, ColquhounDA, McKinneyWE, et al. . Incidence and risk factors for acute kidney injury after spine surgery using the RIFLE classification. J Neurosurg Spine, 2014, 20(5): 505-511 PMID: 24654744

[25] SpitalA. Physiological approach to assessment of acidbase disturbances. N Engl J Med, 2015, 372(2): 193 PMID: 25564914

[26] DuzovaA, BakkalogluA, KalyoncuM, et al. . Etiology and outcome of acute kidney injury in children. Pediatr Nephrol, 2010, 25(8): 1453-1461 PMID: 20512652

[27] LiZ, KangZ, DuanC, et al. . Clinical and pathological features of acute kidney injury in children. Ren Fail, 2014, 36(7): 1023-1028 PMID: 24844885

[28] SymonsJM, ChuaAN, SomersMJ, et al. . Demographic characteristics of pediatric continuous renal replacement therapy: A report of the prospective pediatric continuous renal replacement therapy registry. Clin J Am Soc Nephrol, 2007, 2(4): 732-738 PMID: 17699489

[29] CaddeoG, WilliamsST, McIntyreCW, et al. . Acute kidney injury in urology patients: Incidence, causes and outcomes. Nephrourol Mon, 2013, 5(5): 955-961 PMCID: 3955286 PMID: 24693501

[30] LozaR, EstremadoyroL, LozaC, et al. . Factors associated with mortality in acute renal failure (ARF) in children. Pediatr Nephrol, 2006, 21(1): 106-109 PMID: 16252111