Title: Changing Spectrum of Pediatric AKI in a Tertiary Hospital in India

Title: Changing spectrum of Pediatric AKI in a tertiary hospital in India

SK Sethi, RK Sharma, M Kumar, S Bazaz, A Bhan, M Dhaliwal, V Raghunathan, M Singh, P Sodhi, N Mohan, V Kher

Medanta, The Medicity Hospital, Gurgaon, Haryana, India, 122001

Background:Acute kidney injury (AKI) is an important condition in hospitalized patients, associated with adverse short- and long term outcomes. Mortality rates in critically ill children with AKI are high, ranging from 9-67%. There are very few prospective studies from developing countries looking at the spectrum and outcome of AKI.

Aims and Objectives:To study the spectrum, incidence and outcomes of AKI (as defined by the Acute Kidney Injury Network classification) in children less than 18 years, admitted to the intensive care units.

MethodsStudy populationInclusion CriteriaPatients younger than 18 years admitted to the intensive care unit and pediatric cardio-thoracic intensive care unit.

Exclusion criteria 1. Patients with known chronic kidney disease (CKD) stage 5 2. Patients requiring short periods (less than 24-hr) of hospital stay, admitted solely for the purpose of observation 3. Patients with jaundice with total bilirubin level >5 mg/dl

Study DesignProspective observational studyStudy periodJan 2012-June 2012Diagnostic criteriaStandard definitions were used for defining AKI (AKIN group), SIRS, sepsis and MODS.

Results:During January to June 2012, sixteen of 152 (10.5%) critically ill patients and 9 of 84 (10.7%) patients who underwent cardiopulmonary bypass developed AKI.

In critically ill children, AKI-I was seen in 12 children, AKI-II in 3 and AKI-III in 1 patient. The child with AKI-III died of sepsis and MODS. The most common etiology of AKI was shock (87.5%), sepsis (43.7%) and MODS (25%).

In children who underwent a cardiopulmonary bypass, 5 developed AKI-I and 4 developed AKI-III and required peritoneal dialysis for AKI and pulmonary edema. All of these four children recovered renal function and are under follow up. Three children died post-operatively, without any AKI during their stay in the ICU.

Conclusions:In this ongoing prospective study, it seems that the spectrum of AKI in tertiary hospitals in developing countries is almost similar to developed countries. AKI is common in critically ill children with septicemia and shock, and those undergoing cardiac surgeries. There is a need to prospectively follow these children on a long term.

Contact:

Dr Sidharth Kumar Sethi Associate Consultant, Pediatric Nephrology Kidney and Urology Institute Gurgaon, Haryana, India, 122001 E Mail: Phone: 91-9868306235