Impact of the severity of AKI using pRIFLE criteria at initiation of renal replacement therapy on clinical outcome of critically ill children

Article Article scientifique Article Impact of the severity of AKI using pRIFLE criteria at initiation of renal replacement therapy on clinical outcome of critically ill children eng 2025-03-12 2025-12 author Reynaud Stephanie 0000-0003-1934-9280 855812 author Parvex Paloma Maria 36046 Département de Pédiatrie, Gynécologie et Obstétrique (PETRI) author Grazioli Serge 503187 Département de Pédiatrie, Gynécologie et Obstétrique (PETRI) 7 10.1007/s44253-025-00068-3 2731-944X https://link.springer.com/10.1007/s44253-025-00068-3 Objective : To evaluate the association between patient outcomes and the severity of acute kidney injury (AKI) at renal replacement therapy (RRT) initiation using the pediatric RIFLE criteria (pRIFLE). Design and setting : Single center, retrospective observational study in a pediatric intensive care unit (PICU). Patients and methods : Data extraction was performed for the first treatment of RRT in children admitted to the PICU between 2008 and 2018. Main results : Ninety-four patients required RRT.84% presented with AKI according to the pRIFLE criteria at RRT initiation (10.1% stage “R” (risk), 8.9% “I” (injury), and 81% “F” (failure)). Mortality was 45.7% with no significant difference between the different degree of AKI according to pRIFLE criteria at RRT initiation. No difference in PICU lengths of stay (LOS), duration of mechanical ventilation, and duration of RRT according to the pRIFLE criteria at RRT initiation. In multivariable logistic regression analysis, non-surgical cardiac disease, an elevated PELOD score and fluid overload at RRT initiation were associated with increased odds of mortality. Increased time spent in stage F (>24h vs early<24H) was associated with longer use of vasoactive support but there was not with mortality, PICU LOS, or duration of mechanical ventilation. Conclusion : The severity of AKI according to the pRIFLE criteria before RRT initiation could not predict mortality or morbidity. The optimal timing to initiate RRT in children remains unknown and the severity of kidney dysfunction appeared to be important but insufficient by itself to predict the clinical outcome of children requiring RRT. Initiation criteria Critical care Pediatrics Dialysis Dewey 618 58 Département de pédiatrie, gynécologie et obstétrique 223 false 424 Réanimation néonatale en salle d'accouchement 696 Intensive care medicine. Paediatric and neonatal 3 1 6e3613cf-a12c-4657-872b-c52819803464 Article (Published version) Public Article_scientifique_from_crossref.pdf 1192133 application/pdf CC BY-4.0 d64fdc36a3b20eeec5d395912435ae2734e44e26bde5ea401b0edd071cbff022 83e87356-e35d-40d8-a183-bae8fda90e33 Supplemental data Public 44253_2025_68_MOESM1_ESM.docx 37885 application/vnd.openxmlformats-officedocument.wordprocessingml.document b748e9ed638c598b0f2ab1858891cecf3c3d2559c3c495607a8dd8ffc79c1923 openAccess Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique

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Impact of the severity of AKI using pRIFLE criteria at initiation of renal replacement therapy on clinical outcome of critically ill children	Intensive care medicine. Paediatric and neonatal			2025	1	0

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Reynaud, Stephanie