Determination of acute kidney damage (ABH) incidence and risk factors according to RIFLE and AKIN classification in patients living in a children intensive care unit

DETERMINATION OF ACUTE KIDNEY DAMAGE (ABH) INCIDENCE AND RISK FACTORS ACCORDING TO RIFLE AND AKIN CLASSIFICATION IN PATIENTS LIVING IN A CHILDREN INTENSIVE CARE UNIT In this study, we aimed to compare the incidence of AKI, risk factors for development of AKI, and the classification of both classes in patients admitted to the Pediatric Intensive Care Unit of Fırat University Hospital. All patients admitted to the Pediatric Intensive Care Unit of Fırat University between 1 February 2018 and 1 January 2019 were prospectively evaluated. Patients with known chronic kidney disease, excretion before 48 hours, who received RRT in the external center were not included in the study. Diagnosis of patients, laboratory values at the time of presentation, outcome status, age, gender, duration of hospitalization in intensive care unit, duration and requirement of IMV, history of chronic disease, regular drug use, PIM-2, PRSIM, GCS score, RRT requirement; diuretic, vasoactive, antimicrobial drug and contrast agent use; basal and maximum creatinine level during hospitalization and the days of hospitalization, the day of AKI, the lowest urine output during hospitalization, pRIFLE and AKIN stages were recorded. pRIFLE and AKIN stages were determined according to the worst degree of creatinine or urine output values. Of the 241 patients in the PICU, 2 were diagnosed with CRF and 40 were hospitalized for less than 48 hours were excluded from the study. Of the 199 patients included in the study, 117 (58.8%) were male and 82 (41.2%) were female and the mean age was 54.8 months. AKI developed in 69 patients (34.6%) according to pRIFLE criteria and in 71 patients (35.6%) according to AKIN criteria. AKI developed most commonly in patients with nephrological disease. AKI were developed more frequently in patients with comorbidity. According to the pRIFLE patient with AKI detected, 11 (15.9%) were at risk, 10 (14.5%) were at the risk of injury and 48 (69.6%) were at failure. Twelve (16.9%) of the patients were in stage 1, 15 (21.1%) were in stage 2, and 44 (62%) were in stage 3 who developed AKI according to AKIN criteria. Compared to patients with and without AKI, statistically significant difference was found between in GCS, PIM-2, PRISM values, additional disease, requirement and duration of IMV treatment, laboratory parameters, blood product, diuretic, inotropic, antimicrobial drugs, hospital stay time and mortality (P<0,05). There was no statistically significant difference between the patients who developed ARF according to RIFLE and AKIN criteria (p> 0.05). In the study, according to pRFILE and AKIN criteria there was a statistically significant difference between patient who developed AKI compared to non-AKI patients were lower survival time in PICU (p<0.05), when examined according to the stages, it was seen that survival time was shortened but it was not statistically significant (p<0.05). Most of the patients in the PICU have developed AKI, and according to the AKIN and pRIFLE classification, the duration of hospitalization is longer and the mortality rates are significantly higher than those without AKI. The use of scoring systems that predict the development of AKI, the determination of risk factors that cause kidney damage, the use of pRIFLE and AKIN classification systems to increase awareness of kidney damage, preventive measures and early initiation of treatment are thought to decrease the sequelae and deaths due to AKI in patients with PICU. Key words: PICU, acute kidney injury, pRIFLE and AKIN criteria.