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Risk factors for development of acute kidney injury and acute kidney disease in critically ill children

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A Correction to this article was published on 05 May 2023

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Abstract

Background

Acute kidney injury (AKI) is common among critically ill children and these children are at risk of developing acute kidney disease (AKD).

Methods

A prospective cohort study was conducted on children aged > 1 month to ≤ 18 years old admitted to the pediatric intensive care unit (ICU) of Hong Kong Children’s Hospital from 6/2020 to 6/2021. The incidences and risk factors of both AKI and AKD were determined.

Results

There were 254 eligible admissions (58.3% in males, with a median age of 4.9 [9.7] years). The overall AKI incidence was 41.7% and 56% of children who remained hospitalized in the pediatric  ICU for ≥ 7 days after acquiring AKI developed AKD. Cardiac surgery, bone marrow transplantation and requirement of inotropes were risk factors for both AKI and AKD. The requirement of non-invasive ventilation [relative risk (RR): 2.625 (1.361, 5.064)], total medication dose [RR 1.006 (1.002, 1.010)] and maximal medication intensity [RR 1.154 (1.038, 1.283)] were additional determinants of AKI. Factors indicating more severe AKI and AKI progression were predictive of AKD development. The overall mortality in the pediatric ICU was 3.1%. AKI was significantly associated with mortality (p < 0.001), longer length of hospitalization in the pediatric ICU (p < 0.001) and hospital stay (p < 0.001). AKD was associated with a lower estimated glomerular filtration rate at discharge from the pediatric ICU (p = 0.036).

Conclusion

AKI and AKD were common among critically ill children, and were associated with significant morbidity and mortality. Few modifiable risk factors, especially those related to nephrotoxic medication exposure, were associated with AKI development and AKD progression.

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Authors and Affiliations

  1. Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Doctor’s Office, 9/F, Tower B, 1 Shing Cheong Road, Kowloon Bay, Kowloon, Hong Kong

    Wun Fung Hui, Wing Lum Cheung, Shu Wing Ku & Kam Lun Hon

  2. Department of Pharmacy, Hong Kong Children’s Hospital, G/F, Tower B, 1 Shing Cheong Road, Kowloon Bay, Kowloon, Hong Kong

    Vivian Pui Ying Chan

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Correspondence to Wun Fung Hui.

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The study complied with Declaration of Helsinki and was conducted in accordance with the approved protocol of the research ethics committee of the Hong Kong Children’s Hospital (HKCH-REC-2020-007). 

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Appendices

Appendix 1

See Table

Table 4 The list of nephrotoxic medication
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4.

Appendix 2

See Fig. 

Fig. 2
figure 2

Study flow chart

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2.

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Hui, W.F., Chan, V.P.Y., Cheung, W.L. et al. Risk factors for development of acute kidney injury and acute kidney disease in critically ill children. J Nephrol 36, 1425–1434 (2023). https://doi.org/10.1007/s40620-023-01613-z

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