A review of acute kidney injury in a single centre paediatric intensive care unit

Background Acute kidney injury (AKI) has been proven to be potentially life threatening. AKI causes renal dysfunction affecting electrolytes and extracellular water handling, and impacts upon the provision of medical therapies. In 2007, the Acute Kidney Injury Network (AKIN) defined AKI as an acute absolute increase in serum creatinine concentration (SrCr) of ≥ 26.4 mmol/L or a ≥50% increase from baseline. We studied AKI in our tertiary referral paediatric intensive care unit (PICU). Methods We retrospectively identified patients admitted to PICU in 2010 who met the diagnostic criteria for AKI and collected their demographic and clinical data from the clinical information system (CIS). Local Ethics Committee approval was not required for this retrospective study. Results In 2010, 727 patients were admitted to PICU with 115 (16%) developing AKI. The average duration of PICU stay was 13 days with an average age of 3.1 years. 45% were females and 55% were males. AKI developed within 24 hours of admission in 39%. All patients were critically ill: 82% received conventional mechanical ventilation and 3% high frequency oscillation; 77% required inotropes; 85% required blood products; 88% received diuretics and 94% received antibiotics. 48% of patients received recognised nephrotoxic agents prior to developing AKI and many were continued in a modified dose despite deteriorating renal function. Either peritoneal dialysis or haemofiltration was required in 20 (17%) patients. 100 patients had a single episode of AKI, 13 had 2, 1 had 3 and 1 had 4 episodes. The mortality was 9%. In 75%, the SrCr returned to baseline at discharge. The majority of patients were not offered a renal follow up. Conclusion The development of AKI is common, especially in critically ill patients who also receive nephrotoxic drugs. Although we could not describe the contribution of AKI on our mortality rate, we recommend careful surveillance. The concomitant use of nephrotoxic drugs may be unavoidable, however with early identification of AKI, modification of therapy may minimise the duration of AKI. The long term renal outcome of AKI in the PICU population is unclear and warrants further investigation.