Acute Kidney Injury in Pediatric Acute Respiratory Distress Syndrome

Shubhi Kaushik, Sindy Villacres, Ruth Eisenberg, Shivanand S. Medar

Research output: Contribution to journalArticle

Abstract

Objectives: To describe the incidence of and risk factors for acute kidney injury (AKI) in children with acute respiratory distress syndrome (ARDS) and study the effect of AKI on patient outcomes. Design: A single-center retrospective study. Setting: A tertiary care children’s hospital. Patients: All patients less than 18 years of age who received invasive mechanical ventilation (MV) and developed ARDS between July 2010 and July 2013 were included. Acute kidney injury was defined using p-RIFLE (risk, injury, failure, loss, and end-stage renal disease) criteria. Interventions: None. Measurements and Main Results: One hundred fifteen children met the criteria and were included in the study. Seventy-four children (74/115, 64%) developed AKI. The severity of AKI was risk in 34 (46%) of 74, injury in 19 (26%) of 74, and failure in 21 (28%) of 74. The presence of AKI was associated with lower Pao2 to Fio2 (P/F) ratio (P =.007), need for inotropes (P =.003), need for diuretics (P =.004), higher oxygenation index (P =.03), higher positive end-expiratory pressure (PEEP; P =.01), higher mean airway pressure (P =.008), and higher Fio2 requirement (P =.03). Only PEEP and P/F ratios were significantly associated with AKI in the unadjusted logistic regression model. Patients with AKI had a significantly longer duration of hospital stay, although there was no significant difference in the intensive care unit stay, duration of MV, and mortality. Recovery of AKI occurred in 68% of the patients. A multivariable model including PEEP, P/F ratio, weight, need for inotropes, and need for diuretics had a better receiver operating characteristic (ROC) curve with an AUC of 0.75 compared to the ROC curves for PEEP only and P/F ratio only for the prediction of AKI. Conclusions: Patients with ARDS have high rates of AKI, and its presence is associated with increased morbidity and mortality.

Original languageEnglish (US)
JournalJournal of Intensive Care Medicine
DOIs
StateAccepted/In press - 2020

Keywords

  • acute kidney injury (AKI)
  • critical care
  • pediatric acute respiratory distress syndrome (PARDS)
  • positive end-expiratory pressure (PEEP)

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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