Nutritional and clinical factors associated with acute kidney injury development in critically ill children.

Autor: Ribeiro de Souza ALC; Joana de Gusmão Children's Hospital, Florianópolis, Santa Catarina, Brazil., Piovezani A; Joana de Gusmão Children's Hospital, Florianópolis, Santa Catarina, Brazil., Ventura JC; Federal University of Santa Catarina, Graduate Program in Nutrition, Florianópolis, Santa Catarina, Brazil., Penido MGMG; Santa Casa de Belo Horizonte Hospital - Pediatric Nephrology Unit, Nephrology Center, Belo Horizonte, Minas Gerais, Brazil. mariagorettipenido@yahoo.com.br.; Federal University of Minas Gerais , Pediatric Nephrology Unit, Belo Horizonte, Minas Gerais, Brazil. mariagorettipenido@yahoo.com.br., Bresolin NL; Joana de Gusmão Children's Hospital, Florianópolis, Santa Catarina, Brazil., Moreno YMF; Federal University of Santa Catarina, Graduate Program in Nutrition, Florianópolis, Santa Catarina, Brazil.
Jazyk: angličtina
Zdroj: Journal of nephrology [J Nephrol] 2023 Dec; Vol. 36 (9), pp. 2601-2611. Date of Electronic Publication: 2023 Nov 03.
DOI: 10.1007/s40620-023-01787-6
Abstrakt: Background: Acute kidney injury (AKI) is common in the pediatric intensive care unit (ICU) and is associated with poorer clinical outcomes. There is scarce data to support an association between nutritional status and nutrient delivery in critically ill pediatric patients. Therefore, the present study aimed to identify the nutritional and clinical factors associated with the development of AKI during pediatric ICU stay.
Methods: This prospective study included critically ill pediatric patients aged < 15 years who were admitted to the medical and surgical pediatric ICU. Clinical, laboratory, nutritional status, nutritional therapy parameters, and AKI data were recorded. Adjusted logistic regression was applied and expressed as odds ratio (OR) and 95% confidence interval (95%CI). P-value < 0.05 was considered significant.
Results: We enrolled 108 patients with a median age of 9 months (interquartile range/IQR 2.4-62.5), and 43.5% developed AKI. Sepsis/septic shock (OR 8.00; 95% CI 2.06-32.51, p = 0.003), higher severity of illness (OR 1.89; 95% CI 1.24-2.90, p = 0.003), hypoalbuminemia (OR 4.11; 95% CI 1.61-10.46, p = 0.006), edema (OR 3.42, 95% CI 1.10-10.67, p = 0.034), fluid overload (OR 3.52, 95% CI 1.56-7.96, p = 0.003), need for mechanical ventilation (OR 3.62, 95% CI 1.45-9.04, p = 0.006) and adequate protein intake (OR 0.79, 95% CI 0.63-1.00, p = 0.048) were associated with development of AKI.
Conclusions: Hypoalbuminemia, need for mechanical ventilation, fluid overload, severity of illness, sepsis/septic shock, and edema were risk factors for AKI in pediatric ICU. Furthermore, adequate protein intake is associated with AKI during pediatric ICU stay, making it important to implement nutritional assessment and nutritional therapy protocols for critically ill pediatric patients.
(© 2023. The Author(s) under exclusive licence to Italian Society of Nephrology.)
Databáze: MEDLINE
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