Pediatric acute kidney injury in the ICU:: an independent evaluation of pRIFLE criteria

Objective: The present study was undertaken to evaluate the practicability of the proposed pediatric RIFLE (pRIFLE) criteria in a patient population at risk for acute kidney injury (AKI) and to analyze the prevalence and association of AKI as defined by pRIFLE with mortality. Design: Retrospective, descriptive cohort study. Setting: Single-center, 9-bed PICU facility. Patients: Children with respiratory failure requiring mechanical ventilation for more than 4 days admitted between January 2002 and December 2006. Intervention: None. Measurements and results: Data of 103 patients were studied. Median age was 4.5 years (range 1 month-17 years). Six patients received renal replacement therapy. Seventeen patients (17%) died. Sixty patients (58%) developed AKI by pRIFLE. Mean time to attainment of the first RIFLE stratum was 1.9 +/- 1.6 days. By pRIFLE, 34 of the 60 patients fulfilled the maximum AKI criteria on the first day after admission based on the estimated creatinine clearance criterion. Patients with AKI according to the pRIFLE scoring system had five times higher mortality than patients without AKI (25 vs. 5%, P < 0.05). Conclusions: We observed a high incidence of significant AKI in a PICU population at risk, which was associated with high mortality. Pediatric RIFLE criteria may guide in the early identification of patients at risk for AKI and in the initiation of therapy.