Incidence, outcomes, and mortality risk factors of acute kidney injury in critically ill children: a tertiary care center study in Saudi Arabia

BACKGROUND:
Acute kidney injury (AKI) is a critical concern in pediatric intensive care units (PICUs) due to its high mortality rate.


OBJECTIVES:
Investigate AKI incidence, outcomes, and mortality-related risk factors among critically ill children.


DESIGN:
Retrospective cohort


SETTING:
A PICU


PATIENTS AND METHODS:
The study included children (aged 4 weeks to 14 years) who were admitted to the PICU from (2016 to 2019) and developed AKI at King Faisal Specialist Hopsital and Research Centre.


MAIN OUTCOMES MEASURES:
AKI incidence, outcomes, and mortality-related risk factors.


SAMPLE SIZE:
111 records of patients with AKI


RESULTS:

Of 969 PICU admissions, 111 cases developed AKI and were entered in the analysis, with an incidence rate of (11.5%). The median age was 43 months [interquartile range (IQR): 16–120], with hematology/oncology conditions being the most prevalent underlying diseases (56.8%). Septic shock and nephrotoxin medications were the leading causes of AKI, accounting for (46.8%) and (45.0%), respectively. Regarding AKI severity, (37.8%) were classified as stage 1, (25.2%) as stage 2, and (37.0%) as stage 3 AKI. As for PICU interventions, the highest was inotropic support (63.1%), followed by mechanical ventilation (56.8%) and renal replacement therapy (23.4%). The PICU mortality rate was (38.7%) (43/111), with no significant association between AKI stage and mortality. However, the multivariable analysis identified bone marrow transplant (BMT) (
P
=.042) and inotropic support (
P
=.001) as significant predictors of mortality.



CONCLUSION:
These findings underscore the importance of early recognition and tailored management of AKI in PICU settings. Despite advancements in critical care, AKI remains a significant challenge, contributing to prolonged hospitalization, mortality, and increased health-care resource utilization. Therefore, more investigation is warranted.


LIMITATIONS:
Retrospective study single-center nature.