Slater Morgan B, Gruneir Andrea, Rochon Paula A, Howard Andrew W, Koren Gideon, Parshuram Christopher S
1Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada. 2Child Health Evaluative Sciences, The Research Institute, The Hospital for Sick Children, Toronto, ON, Canada. 3Department of Family Medicine, University of Alberta, Edmonton, AB, Canada. 4Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. 5Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. 6Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. 7Department of Medicine, University of Toronto, Toronto, ON, Canada. 8Division of Orthopedic Surgery, The Hospital for Sick Children, Toronto, ON, Canada. 9Department of Surgery, University of Toronto, Toronto, ON, Canada. 10Department of Pediatrics, University of Toronto, Toronto, ON, Canada. 11Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, ON, Canada. 12Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Pediatr Crit Care Med. 2016 Sep;17(9):e391-8. doi: 10.1097/PCC.0000000000000859.
Acute kidney injury may be promoted by critical illness, preexisting medical conditions, and treatments received both before and during ICU admission. We aimed to estimate the frequency of acute kidney injury during ICU treatment and to determine factors, occurring both before and during the ICU stay, associated with the development of acute kidney injury.
Cohort study of critically ill children.
University-affiliated PICU.
Eligible patients were admitted to the ICU between January 2006 and June 2009. We excluded those admitted with known primary renal failure, chronic renal failure or postrenal transplant, conditions with known renal complications, or metabolic conditions treated with dialysis. Patients were also excluded if they had a short ICU stay (< 6 hr) and those who had no creatinine or urine output measurements during their ICU stay.
None.
Of the 3,865 pediatric patients who met the inclusion criteria, 915 (23.7%) developed acute kidney injury, as classified by the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease criteria, during their ICU stay. Patients at high risk for development of acute kidney injury included those urgently admitted to the ICU (adjusted odds ratio, 1.88), those who developed respiratory dysfunction during their ICU care (adjusted odds ratio, 2.90), and those who treated with extracorporeal membrane oxygenation (adjusted odds ratio, 2.72). The single greatest risk factor for acute kidney injury was the administration of nephrotoxic medications during ICU admission (adjusted odds ratio, 3.37).
This study, the largest evaluating the incidence of RIFLE-defined acute kidney injury in critically ill children, found that one-quarter of patients admitted to the ICU developed acute kidney injury. We identified a number of potentially modifiable risk factors, the largest of which was the administration of nephrotoxic medication. The results of this study may be used to inform targeted interventions to reduce acute kidney injury and improve the outcomes of critically ill children.
危重病、既往病史以及重症监护病房（ICU）入院前和入院期间接受的治疗均可能促使急性肾损伤的发生。我们旨在评估ICU治疗期间急性肾损伤的发生率，并确定在ICU住院前和住院期间与急性肾损伤发生相关的因素。
对危重症儿童进行队列研究。
大学附属医院的儿科重症监护病房（PICU）。
符合条件的患者于2006年1月至2009年6月期间入住ICU。我们排除了那些已知患有原发性肾衰竭、慢性肾衰竭或肾移植后、已知有肾脏并发症的疾病或接受透析治疗的代谢性疾病的患者。如果患者在ICU的住院时间较短（<6小时），以及那些在ICU住院期间未进行肌酐或尿量测量的患者也被排除。
无。
在符合纳入标准的3865例儿科患者中，915例（23.7%）在ICU住院期间根据风险、损伤、衰竭、肾功能丧失和终末期肾病标准被诊断为急性肾损伤。发生急性肾损伤风险较高的患者包括那些紧急入住ICU的患者（校正比值比，1.88）、在ICU治疗期间出现呼吸功能障碍的患者（校正比值比，2.90）以及接受体外膜肺氧合治疗的患者（校正比值比，2.72）。急性肾损伤的最大单一危险因素是在ICU住院期间使用肾毒性药物（校正比值比，3.37）。
本研究是评估危重症儿童中RIFLE定义的急性肾损伤发生率的最大规模研究，发现四分之一的ICU入院患者发生了急性肾损伤。我们确定了一些可能可改变的危险因素，其中最大的因素是使用肾毒性药物。本研究结果可用于指导有针对性的干预措施，以减少急性肾损伤并改善危重症儿童的预后。
