Impact of Acute Kidney Injury pRIFLE Criteria Implementation in Pediatric Critical Care

Abstract

Aims: The study aims to assess the impact of using pRIFLE criteria to define the incidence, the main causes, outcome, and associated morbidity of AKI at SQUH pediatric ICU. Also, we aim to implement a guideline for the early detection and management of AKI in critically sick Omani children. Study Design:  A retrospective study included Omani children, less than 14 years, admitted to Pediatric intensive care, with Acute kidney injury. Place and Duration of Study: The study was conducted between 2016-2017 in Sultan Qaboos University Hospital, PICU. Methodology: AKI diagnosis and staging were based on pRIFLE criteria. Serum creatinine level and Urine output (UOP) were enrolled for all patients. Estimated Creatinine Clearance (eCrCL) was calculated using the Schwartz formula. Data was compiled using SPSS software using the chi-square test and fisher’s exact test. Results: Out of 499 cases, 469 cases were included while 30 cases were excluded. The incidence of AKI was 9.17% (43). Stage ‘Risk (R)’, ‘Injury (I)’ and ‘Failure (F)’ constituted 32.6% (14), 27.9% (12) and 39.5% (17) respectively. Children below five years were more developing AKI with a frequency of 79.07% (p= 0.80). UOP and serum creatinine classification were matching in 42.11%. In regards the primary cause of AKI, Ventilators had the highest frequency (88.4%), followed by Hypotension (65.1%), Sepsis (58.1%), and nephrotoxic drug (14.50%). Prerenal causes constituted 88.47% and renal 11.63%. Conclusion: pRIFLE criteria are an easy tool for early identification and stratification of AKI. A higher incidence of AKI patients was in the failure stage on admission with preventable and treatable Pre-renal causes. Ventilation is still the main concern of AKI in critical children. Nevertheless, Hypotension, sepsis, and drugs are the main risk factor contributing to AKI.