Risk factors for acute renal failure in critically ill children: a prospective descriptive epidemiologic study

Introduction

There are no prospective studies on incidence, risk factors and clinical outcome of acute renal failure (ARF) in critically ill children. The aim of this study was to characterize the risk factors, to determine the incidence rate and to estimate the clinical outcome of ARF in pediatric intensive care unit (PICU).

Methods

We conducted a prospective descriptive study of 1047 consecutively admitted children over 1 year, in a tertiary university PICU. Clinical data were recorded daily, until death or discharge from the PICU. ARF was defined as doubling of serum creatinine. Risk factors for ARF were estimated comparing ARF patients versus non-ARF (nARF) by calculating the relative risk (RR) and 95% confidence interval (95% CI).

Results

Among 985 admissions available for analysis, there were 44 episodes of ARF (4.5%). Mean age (months) was higher in the ARF patients compared with the nARF (111.0 ± 74.9 versus 72.3 ± 68.6; P < 0.001). Significant risk factors for ARF were (RR; 95% CI): age > 12 years old (3.5; 1.5–7.7), admission PRISM score > 10 (4.0; 1.6–10), shock (7.1; 3.4–14.6), and organ dysfunction (hematologic, cardiovascular and neurologic). Mortality was higher in ARF patients; 29.6% versus 2.3% (P < 0.001).

Conclusion

Incidence of ARF is important in the PICU, and is associated with significant mortality. Risk factors are multiple and could be preventable. This is the first prospective epidemiologic study that focuses on pediatric ARF in PICU. A multicentric study is planned to confirm these results.