Effect of different fluid resuscitation on kidney function in pediatric patients with sepsis

Abstract

Objective To prospectively study the effects of different fluid resuscitation on kidney function in pediatric patients with sepsis. Methods One hundred and eighteen pediatric patients with sepsis shock who needed fluid resuscitation in Intensive Care Unit, Zhengzhou Children's Hospital from June 2012 to June 2015 were selected, and they were randomly divided into group A, B and C by random number in the table.The patients received fluid resuscitation of hydroxyethyl starch, 50 g/L albumin and 9 g/L saline.After that, neutrophil gelatinase associated lipocalin (NGAL), α-1 microglobulin, urea nitrogen, creatinine, urine volume, the incidence of acute kidney injury (AKI), and the renal replacement therapy rate accepted by the patients were recorded.Then all the data were analyzed with SPSS 19.0 software. Results Serum levels of NGAL and α-1 microglobulin in group A [(103.50±1.23) μg/L, (3.32±0.20) mg/L]were higher than those in group B [(93.54±1.42) μg/L, (2.71±0.18)mg/L]and group C[(79.57±1.54) μg/L, (2.08±0.14) mg/L], which were statistically different(all P 0.05). The urine volume in group A [(0.50±0.12) mL/(kg·h)] was less than that in group B[(0.90±0.23) mL/(kg·h)] and group C[(1.30±0.14) mL/(kg·h)], which was statistically different(all P 0.05). In three groups, there were 13 cases(34.2%) with AKI in group A, 9 cases(23.1%) with AKI in group B, and 8 cases(19.5%) with AKI in group C, the incidence of AKI in group C was less than that in group B and group C, which was statistically different(χ2=12.74, 10.43; all P<0.05). All the groups all had children accepted renal replacement therapy, there were 8 cases(21.1%)in group A, 7 cases(17.9%)in group B, and 6 cases (14.6%)in group C, and the cases who accepted renal replacement therapy rate in group C were less than those in group A and group B, which was statistically different(χ2=11.36, 8.73; all P<0.05). Conclusions The adverse effect of 9 g/L saline on kidney function is less than hydrox-yethyl starch and 50 g/L albumin, and hydroxyethyl starch has more adverse effects on kidney.Thus, 9 g/L saline is a better option for fluid resuscitation in pediatric sepsis patients. Key words: Fluid resuscitation; Sepsis; Kidney function; Child