Prevalence and Risk Factors of Acute Renal Failure in PICU Based on RIFLE Scoring System

Acute Renal Failure (ARF) is a common complication in Pediatric Intensive Care Units (PICUs) and its quick diagnosis at the bedside is of utmost importance. Various systems have been introduced for the rapid diagnosis of the condition. One of these systems is RIFLE, which based on Glomerular filteration rate (GFR) and urinary output, ARF patients are divided into 5 categories namelyRisk group, Injury group, Failure group, Loss of function, and End stage renal disease. At present we donot have enough data from our centers. The aim of this study was to evaluate the prevalence and risk factors of acute renal failure in PICU. This is a cross sectional study conducted between 2006-2007 on 121 patients admitted to PICU of Mofid Childrens Hospital. We evaluated our patients with demographic data, biochemistry and glomerular filtration rate. Based on patients renal function test and 24 hr urinary output, patient's were placed in one of the 5 groups of the RIFLE system. Prevalence of renal failure and the associated risk factors were evaluated. We also used Regression analysis test, t test, Chi², ANOVA and post hoc test for statistic analysis. We evaluated 121 pediatric patients; 65 cases were males (53.72%) and the rest were females. The prevalence of acute renal failure in our patients was 36.4%. Based upon the RIFLE scoring system 19.8% of our patients were in Risk group, 8.3% were in Injury group and 8.3% were in the other three groups. We found out a significant correlation between patient's Glomerular Filtration Rate(GFR) and diastolic blood pressure, platelet level, pH, PaCo2 and PaO2 and serum bicarbonate (p value 0.038,0.037, 0.044, 0.008, 0.004, and 0.004, respectively). There wasn’t any correlation between GFR and age, sex and urine output at the time of admission. Therefore there could be a relation between these factors and ARF in Intensive care units. We conclude that the incidence of Acute renal failure in ICU centers has significantly increased and hypotension, hypoxemia, acidosis and thrombocytopenia are the major risk factors for this disorder.