Likhitha Siddarajaiah, Rameshkumar Ramachandran, Delhikumar Chinnaiah Govindhareddy, Selvan Tamil
Department of Pediatrics, JIPMER, Gorimedu, Puducherry, India.
Indian J Nephrol. 2025 May-Jun;35(3):373-379. doi: 10.25259/IJN_79_2024. Epub 2024 Aug 1.
There are two criteria to diagnose and stage acute kidney injury (AKI) in children: pediatric-Risk, Injury, Failure, Loss (p-RIFLE) and Kidney Disease Improving Global Outcomes (KDIGO). This study aims to find out the extent of agreement in diagnosis (by p-RIFLE and KDIGO) and risk factors of AKI in pediatric diabetic ketoacidosis (DKA).
A retrospective cohort study involving children aged ≤15 years with DKA was conducted between January 2014 and December 2022. Those with inborn errors of metabolism, septic shock, and urinary tract disease were excluded. The primary outcome was the extent of agreement in diagnosis of AKI by p-RIFLE and KDIGO. The secondary outcomes were staging agreement, risk factors, complications (hypoglycemia, hypokalemia, and cerebral edema), time to resolution of DKA, and hospital and pediatric intensive care units (PICU) stay.
Data from 161 patients were collected. Mean (SD) age was 8.6 (3.7) years. Good agreement between p-RIFLE and KDIGO criteria for diagnosis of AKI was noted at admission (Kappa = 0.71, p ≤ 0.001), at 24 hours (Kappa = 0.73, p ≤ 0.001) and discharge (Kappa = 0.60, p ≤ 0.001), and for the staging of AKI at admission (Kappa = 0.81, p ≤ 0.001) at 24 hours (Kappa = 0.75, p ≤ 0.001) and discharge (Kappa = 0.48, p ≤ 0.001). On multivariate analysis, age (≤5 years: aOR = 3.03, 95% CI 1.04-8.79) is an independent risk factor for AKI at discharge by KDIGO. Cerebral edema (n = 6, 3.7%), hypoglycemia (n = 66, 41%), and hypokalemia (n = 59, 36.6%) were noted. Resolution and stay in PICU and hospitals were longer for patients with AKI.
p-RIFLE and KDIGO criteria showed good agreement in diagnosis and staging of AKI in pediatric DKA.
儿童急性肾损伤（AKI）的诊断和分期有两个标准：儿童风险、损伤、衰竭、丧失（p-RIFLE）和改善全球肾脏病预后组织（KDIGO）。本研究旨在探讨儿童糖尿病酮症酸中毒（DKA）中AKI诊断（采用p-RIFLE和KDIGO标准）的一致性程度及危险因素。
对2014年1月至2022年12月期间年龄≤15岁的DKA儿童进行回顾性队列研究。排除患有先天性代谢缺陷、感染性休克和泌尿系统疾病的儿童。主要结局是采用p-RIFLE和KDIGO标准诊断AKI的一致性程度。次要结局包括分期一致性、危险因素、并发症（低血糖、低钾血症和脑水肿）、DKA缓解时间以及住院时间和儿科重症监护病房（PICU）住院时间。
收集了161例患者的数据。平均（标准差）年龄为8.6（3.7）岁。p-RIFLE和KDIGO标准在入院时（Kappa = 0.71，p≤0.001）、24小时时（Kappa = 0.73，p≤0.001）和出院时（Kappa = 0.60，p≤0.001）对AKI诊断的一致性良好，在入院时（Kappa = 0.81，p≤0.001）、24小时时（Kappa = 0.75，p≤0.001）和出院时（Kappa = 0.48，p≤）对AKI分期的一致性也良好。多因素分析显示，年龄（≤5岁：校正比值比 = 3.03，95%置信区间1.04 - 8.79）是KDIGO标准下出院时AKI的独立危险因素。观察到6例（3.7%）发生脑水肿、66例（41%）发生低血糖和59例（36.6%）发生低钾血症。AKI患者在PICU和医院的缓解时间和住院时间更长。
p-RIFLE和KDIGO标准在儿童DKA的AKI诊断和分期方面显示出良好的一致性。
