Acute kidney injury in children hospitalized for acute gastroenteritis: prevalence and risk factors,Pediatric Nephrology

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Acute kidney injury in children hospitalized for acute gastroenteritis: prevalence and risk factors
Pediatric Nephrology ( IF 2.6 ) Pub Date : 2021-01-07 , DOI: 10.1007/s00467-020-04834-7
Pierluigi Marzuillo ₁ , Maria Baldascino _{1,

2} , Stefano Guarino ₁ , Silverio Perrotta ₁ , Emanuele Miraglia Del Giudice ₁ , Felice Nunziata ₂

Affiliation

Background

We aimed to evaluate prevalence of acute kidney injury (AKI) and its risk factors in children hospitalized for acute gastroenteritis (AGE) to identify early predictors of AKI.

Methods

We retrospectively collected clinical and biochemical data of 114 children (57.9% male; mean age 2.9 ± 2.8 years) hospitalized for AGE. AKI was defined according to Kidney Disease/Improving Global Outcomes creatinine criteria. We considered basal serum creatinine as value of creatinine estimated with Hoste (age) equation assuming basal eGFRs were median age-based eGFR normative values for children ≤ 2 years of age, and eGFR 120 mL/min/1.73m² for children > 2 years. Univariate and multivariate logistic regression models were used to explore associations with AKI. We included in multivariate analyses only variables with significant p after Bonferroni correction.

Results

AKI was found in 28/114 (24.6%) patients. No patients required hemodialysis, 2 (1.8%) reached AKI stage 3, 2 (1.8%) AKI stage 2, and 24 (21.0%) AKI stage 1. Mean length of stay was 3.6 ± 1.2, 5.0 ± 1.8, and 10.5 ± 5.8 days, for patients with no, mild, and severe AKI (p < 0.001), respectively. Duration of symptoms before hospitalization (OR = 2.5; 95% CI = 1.3–5.0; p = 0.006), dehydration > 5% (OR = 43.1; 95% CI = 5.4–344.1; p = < 0.001), and serum bicarbonate levels (OR = 1.6; 95% CI = 1.2–2.1; p = 0.001) were independent predictors of AKI.

Conclusions

About one quarter of patients hospitalized for AGE may suffer from AKI with a longer stay for patients with more severe AKI. Particular attention, however, should be paid to volemia and kidney health of patients with AGE especially in the presence of increased duration of symptoms before hospitalization, dehydration, and lower serum bicarbonate levels.

Graphical abstract

中文翻译：

急性胃肠炎住院儿童的急性肾损伤：患病率和危险因素

背景

我们旨在评估急性肾损伤 (AKI) 的患病率及其在因急性胃肠炎 (AGE) 住院的儿童中的危险因素，以确定 AKI 的早期预测因素。

方法

我们回顾性收集了 114 名因 AGE 住院的儿童（57.9% 男性；平均年龄 2.9 ± 2.8 岁）的临床和生化数据。AKI 是根据肾脏疾病/改善全球结果肌酐标准定义的。我们将基础血清肌酐值视为使用 Hoste（年龄）方程估计的肌酐值，假设基础 eGFR 是 ≤ 2 岁儿童的基于年龄的 eGFR 中值标准值，大于 2 岁儿童的 eGFR 为 120 mL/min/ 1.73m ² . 单变量和多变量逻辑回归模型用于探索与 AKI 的关联。我们在多变量分析中仅包括在Bonferroni 校正后具有显着p的变量。

结果

28/114 (24.6%) 名患者发现 AKI。没有患者需要进行血液透析，2 人 (1.8%) 达到 AKI 3 期，2 人 (1.8%) AKI 2 期，24 人 (21.0%) AKI 1 期。平均住院时间分别为 3.6 ± 1.2、5.0 ± 1.8 和 10.5 ±对于无、轻度和重度 AKI 的患者，分别为 5.8 天（p < 0.001）。住院前症状持续时间（OR = 2.5；95% CI = 1.3–5.0；p = 0.006），脱水 > 5%（OR = 43.1；95% CI = 5.4–344.1；p = < 0.001）和血清碳酸氢盐水平（OR = 1.6；95% CI = 1.2–2.1；p = 0.001）是 AKI 的独立预测因子。