Acute kidney injury is a frequent complication in critically ill neonates receiving extracorporeal membrane oxygenation: a 14-year cohort study

被引:111
作者
Zwiers, Alexandra J. M. [1 ,2 ,4 ]
de Wildt, Saskia N. [1 ,2 ]
Hop, Wim C. J. [3 ]
Dorresteijn, Eiske M. [4 ]
Gischler, Saskia J. [1 ,2 ]
Tibboel, Dick [1 ,2 ]
Cransberg, Karlien [4 ]
机构
[1] Erasmus Univ, Rotterdam, Netherlands
[2] Erasmus Univ, Dept Pediat Surg, NL-3000 DR Rotterdam, Netherlands
[3] Erasmus Univ, Dept Epidemiol & Biostat, NL-3000 DR Rotterdam, Netherlands
[4] Sophia Childrens Univ Hosp, Erasmus Med Ctr, Dept Pediat Nephrol, NL-3015 GJ Rotterdam, Netherlands
来源
CRITICAL CARE | 2013年 / 17卷 / 04期
关键词
Critical care; acute kidney injury; extracorporeal membrane oxygenation (ECMO); RIFLE; serum creatinine; ACUTE-RENAL-FAILURE; INTENSIVE-CARE-UNIT; LENGTH-OF-STAY; SERUM CREATININE; EARLY-DIAGNOSIS; CHILDREN; BIOMARKERS; MORTALITY; EXCRETION; CRITERIA;
D O I
10.1186/cc12830
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Introduction: Newborns in need of extracorporeal membrane oxygenation (ECMO) support are at high risk of developing acute kidney injury (AKI). AKI may occur as part of multiple organ failure and can be aggravated by exposure to components of the extracorporeal circuit. AKI necessitates adjustment of dosage of renally eliminated drugs and avoidance of nephrotoxic drugs. We aimed to define systematically the incidence and clinical course of AKI in critically ill neonates receiving ECMO support. Methods: This study reviewed prospectively collected clinical data (including age, diagnosis, ECMO course, and serum creatinine (SCr)) of all ECMO-treated neonates within our institution spanning a 14-year period. AKI was defined by using the Risk, Injury, Failure, Loss of renal function, and End-stage renal disease (RIFLE) classification. SCr data were reviewed per ECMO day and compared with age-specific SCr reference values. Accordingly, patients were assigned to RIFLE categories (Risk, Injury, or Failure as 150%, 200%, or 300% of median SCr reference values). Data are presented as median and interquartile range (IQR) or number and percentage. Results: Of 242 patients included, 179 (74%) survived. Median age at the start of ECMO was 39 hours (IQR, 26 to 63); median ECMO duration was 5.8 days (IQR, 3.9 to 9.4). In total, 153 (64%) patients had evidence of AKI, with 72 (30%) qualifying as Risk, 55 (23%) as Injury, and 26 (11%) as Failure. At the end of the study period, only 71 (46%) patients of all 153 AKI patients improved by at least one RIFLE category. With regression analysis, it was found that nitric oxide ventilation (P = 0.04) and younger age at the start of ECMO (P = 0.004) were significant predictors of AKI. Survival until intensive care unit discharge was significantly lower for patients in the Failure category (35%) as compared with the Non-AKI (78%), Risk (82%), and Injury category (76%), with all P < 0.001, whereas no significant differences were found between the three latter RIFLE categories. Conclusions: Two thirds of neonates receiving ECMO had AKI, with a significantly increased mortality risk for patients in the Failure category. As AKI during childhood may predispose to chronic kidney disease in adulthood, long-term monitoring of kidney function after ECMO is warranted.
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页数:10
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共 29 条
[1]   Modified RIFLE criteria in critically ill children with acute kidney injury [J].
Akcan-Arikan, A. ;
Zappitelli, M. ;
Loftis, L. L. ;
Washburn, K. K. ;
Jefferson, L. S. ;
Goldstein, S. L. .
KIDNEY INTERNATIONAL, 2007, 71 (10) :1028-1035
[2]   Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study [J].
Alkandari, Omar ;
Eddington, K. Allen ;
Hyder, Ayaz ;
Gauvin, France ;
Ducruet, Thierry ;
Gottesman, Ronald ;
Phan, Veronique ;
Zappitelli, Michael .
CRITICAL CARE, 2011, 15 (03)
[3]   Acute kidney injury and renal replacement therapy independently predict mortality in neonatal and pediatric noncardiac patients on extracorporeal membrane oxygenation [J].
Askenazi, David J. ;
Ambalavanan, Namasivayam ;
Hamilton, Kiya ;
Cutter, Gary ;
Laney, Debbie ;
Kaslow, Richard ;
Georgeson, Keith ;
Barnhart, Douglas C. ;
Dimmitt, Reed A. .
PEDIATRIC CRITICAL CARE MEDICINE, 2011, 12 (01) :E1-E6
[4]   Risk factors of acute renal failure in critically ill children:: A prospective descriptive epidemiological study [J].
Bailey, Dennis ;
Phan, Veronique ;
Litalien, Catherine ;
Ducruet, Thierry ;
Merouani, Aicha ;
Lacroix, Jacques ;
Gauvin, France .
PEDIATRIC CRITICAL CARE MEDICINE, 2007, 8 (01) :29-35
[5]   Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group [J].
Bellomo, R ;
Ronco, C ;
Kellum, JA ;
Mehta, RL ;
Palevsky, P .
CRITICAL CARE, 2004, 8 (04) :R204-R212
[6]   Haemofiltration in newborns treated with extracorporeal membrane oxygenation: a case-comparison study [J].
Blijdorp, Karin ;
Cransberg, Karlien ;
Wildschut, Enno D. ;
Gischler, Saskia J. ;
Houmes, Robert Jan ;
Wolff, Eric D. ;
Tibboel, Dick .
CRITICAL CARE, 2009, 13 (02)
[7]   Reference values for serum creatinine in children younger than 1 year of age [J].
Boer, Dirk P. ;
de Rijke, Yolanda B. ;
Hop, Wim C. ;
Cransberg, Karlien ;
Dorresteijn, Eiske M. .
PEDIATRIC NEPHROLOGY, 2010, 25 (10) :2107-2113
[8]   Acute kidney injury in congenital diaphragmatic hernia requiring extracorporeal life support: an insidious problem [J].
Gadepalli, Samir K. ;
Selewski, David T. ;
Drongowski, Robert A. ;
Mychaliska, George B. .
JOURNAL OF PEDIATRIC SURGERY, 2011, 46 (04) :630-635
[9]   Acute Kidney Injury in Children and Its Potential Consequences in Adulthood [J].
Goldstein, Stuart L. .
BLOOD PURIFICATION, 2012, 33 (1-3) :131-137
[10]   Acute kidney injury in childhood: should we be worried about progression to CKD? [J].
Goldstein, Stuart L. ;
Devarajan, Prasad .
PEDIATRIC NEPHROLOGY, 2011, 26 (04) :509-522