Using pRIFLE criteria for acute kidney injury in critically ill children

Abstract

Backgi-ound Incidence of acute kidney injury (AKI) in critically ill
children and its mortality rate is high. The lack of a uniform definition
for AKI leads to failure in determining kidney injury, delayed
treatment, and the inability to generalize research results.
Objectives To evaluate the pediatric RIFLE (pRIFLE) criteria (risk
for renal dysfunction, injury to the kidney, failure of kidney function,
loss of kidney function, and end-stage renal disease) for diagnosing
and following the clinical course of AKI in critically ill children. We
also aimed to compare AKI severity on days 1 and 3 of pediatric
intensive care unit (PICU) stay in critically ill pediatric patients.
Methods This prospective cohort study was performed in PICU
patients. Urine output (UOP), serum creatinine (SCr) , and
glomerular filtration rate on days 1 and 3 of PICU stay were
recorded. Classification of AKI was determined according to
pRIFLE criteria. We also recorded subjects' immune status,
pediatric logistic organ dysfunction (PELOD) score, admission
diagnosis, the use of vasoactive medications, diuretics, and
ventilators, as well as PICU length of stay and mortality.
Results Forty patients were enrolled in this study. AKI was
found in 13 patients (33%). A comparison of AKI severity on
day 1 and day 3 revealed no statistically significant differences for
attainment of pRIFLE criteria by urine output only (pRIFLfu0 p;
P=0.087) and by both UOP and SCr (pRIFLEcr+uo p; P= 0.577).
However, attainment of pRIFLE criteria by SCr only (pRIFLEcrl
was significantly improved between days 1 and 3 (P =0.026). There
was no statistically significant difference in mortality or length of
stay between subjects with AKI and those without AKI.
Conclusion The pRIFLE criteria is feasible for use in diagnosing
and following the clinical course of AKI in critically ill children.