POS-060 CHRONIC KIDNEY DISEASE IN PEDIATRIC ACUTE KIDNEY INJURY SURVIVORS FROM INTENSIVE CARE UNIT: PROSPECTIVE STUDY FROM A DEVELOPING COUNTRY

Abstract

Acute kidney injury (AKI) is an independent risk factor for mortality in critically il. Incidence of AKI in PICU ranges from 8-30%. Despite advances in therapy, mortality is still high and survivors are at risk of CKD. A hospital based prospective cohort study was conducted on critically ill children and neonates with AKI admitted to SAT Hospital, a tertiary care teaching hospital in South India over a period of 1 year with the objective to assess the immediate and long term outcome and risk factor involved in adverse outcome. Adverse outcome is defined as mortality or development of CKD in survivors. AKI was defined by pRIFLE and nRIFLE criteria respectively in children and neonates. Those with pre-existing CKD or CAKUT were excluded. The demographic profile, etiology, organ dysfunction, inotrope support, mechanical ventilation, AKI severity, need for dialysis and condition at discharge were assessed. Survivors were followed up with assessment of blood pressure, proteinuria and e GFR by Schwartz formula at 3 months, 6 months and 1 year. GFR below 90 mL/min/1.73 m2 or a normal GFR with proteinuria and/or hypertension were used to identify CKD. Statistical analysis was done with SPSS 20.0 .Chi square test was used for discrete variables, t test and ANOVA for quantitative variables. Univariate analysis and binary logistic regression were done for assessment of factors affecting the outcome. 155 critically ill babies- 87 neonates and 68 children were diagnosed with AKI during the study period. Male to Female ratio was 4.1:1 for new-born and 1.8:1 for children. Out of the 87 neonates 25.3% (22) were at risk, 43.7 % (38) in injury and 31 % (27) had failure. Dehydration due to faulty feeding and lactation failure formed the major cause of neonatal AKI (50.6%) followed by septicaemia (28.7%). Of the 68 children 17.7% (12), 23.5 % (16) and 58.8% (40) were in risk, injury and failure respectively. Acute Glomerulonephritis was the major etiology (23.5%) followed by sepsis with MODS (19.1%). Significant association was found between mortality and severity of AKI in both neonates and children. (P 0.002, P 0.00). Significant risk factors of mortality are given in Table 1.View Large Image Figure ViewerDownload Hi-res image Download (PPT) 13 out of 87 neonates expired (14.9%). 83.7% had normal GFR at discharge. 8.6% (3/35) with Injury and 53% (9/17) with Failure had partial recovery. 74 survivors were followed up for 1 year. 12 were lost to follow up and 1 died at 3 months. 4/61 babies (6.5%) developed CKD - 11% with injury and 14.2% with failure. Of the 68 children, 15 expired (22%). Among 53 survivors, 27 (51%) – {33.3 % (5/15) with injury and 80.8 % (21/26)} had abnormal GFR at discharge. 48 children were followed up till 1 year. 22.9% (11) had CKD . Of this 20% (3/15) were with injury and 36% (8/22) with failure. Severity of AKI correlated with adverse outcome. Risk factors for CKD were anuric AKI, MODS, need for dialysis, component therapy, inotrope support, abnormal GFR and hypertension at discharge. Anuric AKI and need for dialysis were the independent risk factors by multivariate analysis for development of CKD (Table 2). 22.9% children and 6.5% neonates surviving an AKI episode had CKD at 1 year follow up. Regardless of the severity, all AKI survivors after critical illness should be monitored regularly for long-term kidney damage so that early intervention becomes possible to retard the progression.