Determination of factors affecting the development of acute kidney injury in the pediatric intensive care unit

This study aimed to determine the incidence of acute kidney injury (AKI) and etiologically effective risk factors in patients admitted to the Pediatric Intensive Care Unit (PICU) of Akdeniz University Faculty of Medicine. All patients aged between 1 month and 18 years who were admitted to Akdeniz University Faculty of Medicine Hospital PICU between December 1, 2021 and December 1, 2022 were prospectively examined. Patients who did not meet the age limits and had known chronic kidney disease were excluded from the study. Patients' age (month), gender, weight, body mass index, malnutrition status, hospitalization diagnosis, presence of known chronic disease, known kidney disease and genitourinary anomaly, basal serum creatinine value and basal glomerular filtration rate (GFR), the highest serum creatinine value and lowest GFR value observed during hospitalization, PRISM and PELOD scores calculated electronically in the first 24 hours of ICU admission, presence of AKI before ICU admission, nephrotoxic drugs used in patients, AKI stages according to pRIFLE and KDIGO criteria, AKI score, albumin level, mechanical ventilation and hypoxia status, daily fluid balance, vasoactive inotrope score, renal angina index (RAI), and presence of perfusion disorder were recorded. Of the 407 patients hospitalized during the study period, 27 were excluded from the study because they had known chronic kidney disease and 2 did not meet the age limits. Of the 378 patients included in the study, 35.7% were girls and their average age was 80 months. In the study group, the average length of intensive care unit stay was 6.96 days, length of hospital stay was 25.7 days, the number of ventilator-free days in the first 28 days was 21.7 days, intubation rate was 63.8%, and mortality rate was 8.9%. AKI development was observed in 31.7% of the patients according to KDIGO, 30.6% according to pRIFLE and 25.9% according to RAI scoring. When the groups with and without AKI were compared, no significant difference was found between demographic data and basal GFR levels, while the presence of hypertension, hypoxia, fluid overload, PRISM score and PELOD score were found to be higher in the AKI group. It was observed that AKI developed within the following 72 hours in 85% of patients with a renal angina index 8. Etiologically causes in the development of AKI are, in order of frequency: It was determined as prerenal (88.3%), renal (18.3%) and postrenal (1.6%). The most frequently used drugs in the study group were antibiotics (70%); It was observed that the most common antibiotics were beta lactams, vancomycin and amikacin, respectively. Apart from these, other frequently used nephrotoxic drugs are acyclovir, furosemide and amphotericin. While the length of intensive care stay was longer in the AKI group, there was no statistically significant difference in the length of hospital stay. VIS score and mortality were higher and GOS was lower in the AKI group (p<0.05). In multiple regression analysis, the presence of AKI was found to be an independent risk factor for mortality. Fluid resuscitation was most frequently used in treatment.