Pediatric acute kidney injury in the ICU: an independent evaluation of pRIFLE criteria

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• 作者：Frans B. Pl?tz (1) <br> Angelique B. Bouma (1) (2) <br> Joanna A. E. van Wijk (2) <br> Martin C. J. Kneyber (1) <br> Arend B?kenkamp (2) <br>
• 关键词：Critically ill children ; Acute kidney injury ; Mortality ; RIFLE ; Pediatrics
• 刊名：Intensive Care Medicine
• 出版年：2008
• 出版时间：September 2008
• 年：2008
• 卷：34
• 期：9
• 页码：1713-1717
• 全文大小：223KB
• 参考文献：1. Bellomo R, Ronco C, Kellum JA, Metha RL, Palevsky P, the ADQI workgroup (2004) Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8:R204–R212 CrossRef <br> 2. Joannidis M (2007) Classification of acute kidney injury: are we there yet? Intensive Care Med 33:572 CrossRef <br> 3. Hoste EAJ, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA (2006) RIFLE criteria for acute kidney injury are associated with hospital moratlity in critically ill patients: a cohort analysis. Crit Care 10:R73 CrossRef <br> 4. Akcan-Arikan A, Zappitelli M, Loftis LL, Wasburn KK, Jefferson LS, Goldstein SL (2007) Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 71:1028-035 CrossRef <br> 5. Ostermann M, Chang RWS (2007) Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med 35:1837-843 CrossRef <br> 6. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813-18 CrossRef <br> 7. Kuiper JW, Groeneveld AB, Slutsky AS, Plotz FB (2005) Mechanical ventilation and acute renal failure. Crit Care Med 33:1408-415 CrossRef <br> 8. Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 34:571-90 <br> 9. Bailey D, Phan V, Litalien C, Ducruet T, Merouani A, Lacroix J, Gauvin F (2007) Risk factors of acute failure in critically ill children: a prospective descriptive epidemiological study. Pediatr Crit Care Med 8:29-5 CrossRef <br> 10. Kellum JA, Angus DC (2002) Patients are dying of acute renal failure. Crit Care Med 30:2156-157 CrossRef <br> 11. Plotz FB, Hulst HE, Twisk JW, Bokenkamp A, Markhorst DG, van Wijk JAE (2005) Effect of acute renal failure on outcome in children with severe septic shock. Pediatr Nephrol 20:1171-181 CrossRef <br>
• 作者单位：Frans B. Pl?tz (1) <br> Angelique B. Bouma (1) (2) <br> Joanna A. E. van Wijk (2) <br> Martin C. J. Kneyber (1) <br> Arend B?kenkamp (2) <br><br>1. Department of Pediatric Intensive Care, VU University Medical Center, P. O. Box?7057, 1007 MB, Amsterdam, The Netherlands <br> 2. Pediatric Nephrology, VU University Medical Center, Amsterdam, The Netherlands <br>

文摘

Objective The present study was undertaken to evaluate the practicability of the proposed pediatric RIFLE (pRIFLE) criteria in a patient population at risk for acute kidney injury (AKI) and to analyze the prevalence and association of AKI as defined by pRIFLE with mortality. Design Retrospective, descriptive cohort study. Setting Single-center, 9-bed PICU facility. Patients Children with respiratory failure requiring mechanical ventilation for more than 4 days admitted between January 2002 and December 2006. Interventions None. Measurements and results Data of 103 patients were studied. Median age was 4.5 years (range 1 month-7 years). Six patients received renal replacement therapy. Seventeen patients (17%) died. Sixty patients (58%) developed AKI by pRIFLE. Mean time to attainment of the first RIFLE stratum was 1.9 ± 1.6 days. By pRIFLE, 34 of the 60 patients fulfilled the maximum AKI criteria on the first day after admission based on the estimated creatinine clearance criterion. Patients with AKI according to the pRIFLE scoring system had five times higher mortality than patients without AKI (25 vs. 5%, P < 0.05). Conclusions We observed a high incidence of significant AKI in a PICU population at risk, which was associated with high mortality. Pediatric RIFLE criteria may guide in the early identification of patients at risk for AKI and in the initiation of therapy.