Acute kidney failure: a pediatric experience over 20 years.

BACKGROUND

Acute kidney failure in children is a catastrophic, life-threatening event.

OBJECTIVE

To compare and contrast 2 decades of data, analyzing the underlying causes, associated multiple organ system failures, outcome of dialysis procedures, and other variables of interest.

DESIGN

Retrospective examination of clinical data collected between January 1, 1979, and December 31, 1998.

SETTING

Regional health care center in the mid-Atlantic area.

PARTICIPANTS

Two hundred twenty-eight patients, aged from 1 day to 18 years, had acute kidney failure and were referred to a pediatric nephrology service.

MAIN OUTCOME MEASURES

Characteristics, percentage of mortality, intensive care unit admission, procedures, and other variables and causes of acute renal failure.

RESULTS

The total number of cases analyzed represented 7% of all patients presented to the pediatric nephrology service. Sex distribution, ethnicity, and survival statistics were unchanged between both decades. The overall survival rate was 73%. One hundred fifty-four patients (68%) were admitted to the pediatric intensive care unit. The following 106 acute extracorporeal procedures were performed on 93 patients (41%): 12 patients received extracorporeal membrane oxygenation, 52 patients underwent peritoneal dialysis, 32 underwent hemodialysis, 3 patients received continuous venovenous hemofiltration, and 7 patients received continuous arteriovenous hemofiltration. Sepsis and burns, other leading causes of acute renal failure in the first decade, are replaced in the second decade by hematologic-oncologic complications and pulmonary failure.

CONCLUSIONS

Acute kidney failure following repair of cardiac lesions remains unchanged as a leading risk factor of mortality in both decades. Three organ system failures were associated with more than a 50% mortality rate. Predialysis low serum albumin concentrations emerged as a significant copredictor of mortality.