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Acute Kidney Failure
A Pediatric Experience Over 20 Years
Debra M. Williams, MD;
Sue S. Sreedhar, MD;
John J. Mickell, MD;
James C. M. Chan, MD
Arch Pediatr Adolesc Med. 2002;156:893-900.
Background Acute kidney failure in children is a catastrophic, life-threatening
event.
Objective To compare and contrast 2 decades of data, analyzing the underlying
causes, associated multiple organ system failures, outcome of dialysis procedures,
and other variables of interest.
Design Retrospective examination of clinical data collected between January
1, 1979, and December 31, 1998.
Setting Regional health care center in the mid-Atlantic area.
Participants Two hundred twenty-eight patients, aged from 1 day to 18 years, had
acute kidney failure and were referred to a pediatric nephrology service.
Main Outcome Measures Characteristics, percentage of mortality, intensive care unit admission,
procedures, and other variables and causes of acute renal failure.
Results The total number of cases analyzed represented 7% of all patients presented
to the pediatric nephrology service. Sex distribution, ethnicity, and survival
statistics were unchanged between both decades. The overall survival rate
was 73%. One hundred fifty-four patients (68%) were admitted to the pediatric
intensive care unit. The following 106 acute extracorporeal procedures were
performed on 93 patients (41%): 12 patients received extracorporeal membrane
oxygenation, 52 patients underwent peritoneal dialysis, 32 underwent hemodialysis,
3 patients received continuous venovenous hemofiltration, and 7 patients received
continuous arteriovenous hemofiltration. Sepsis and burns, other leading causes
of acute renal failure in the first decade, are replaced in the second decade
by hematologic-oncologic complications and pulmonary failure.
Conclusions Acute kidney failure following repair of cardiac lesions remains unchanged
as a leading risk factor of mortality in both decades. Three organ system
failures were associated with more than a 50% mortality rate. Predialysis
low serum albumin concentrations emerged as a significant copredictor of mortality.
From the Departments of Pediatrics (Drs Williams, Sreedhar, Mickell,
and Chan) and Biochemistry Molecular Biophysics (Dr Chan), Virginia Commonwealth
University, Richmond. Dr Chan is now with The Barbara Bush Children's Hospital,
Maine Medical Center, Portland, and the Department of Pediatrics, University
of Vermont College of Medicine, Burlington.
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