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Identifying Risk for Acute Kidney Injury in Infants and Children Following Cardiac Arrest*

Neumayr, Tara M. MD1,2; Gill, Jeff PhD3–5; Fitzgerald, Julie C. MD, PhD6; Gazit, Avihu Z. MD1; Pineda, Jose A. MD1,7; Berg, Robert A. MD6; Dean, J. Michael MD, MBA8; Moler, Frank W. MD, MS9; Doctor, Allan MD1,10

Pediatric Critical Care Medicine: October 2017 - Volume 18 - Issue 10 - p e446–e454
doi: 10.1097/PCC.0000000000001280
Online Clinical Investigations

Objectives: Our goal was to identify risk factors for acute kidney injury in children surviving cardiac arrest.

Design: Retrospective analysis of a public access dataset.

Setting: Fifteen children’s hospitals associated with the Pediatric Emergency Care Applied Research Network.

Patients: Two hundred ninety-six subjects between 1 day and 18 years old who experienced in-hospital or out-of-hospital cardiac arrest between July 1, 2003, and December 31, 2004.

Interventions: None.

Measurements and Main Results: Our primary outcome was development of acute kidney injury as defined by the Acute Kidney Injury Network criteria. An ordinal probit model was developed. We found six critical explanatory variables, including total number of epinephrine doses, postcardiac arrest blood pressure, arrest location, presence of a chronic lung condition, pH, and presence of an abnormal baseline creatinine. Total number of epinephrine doses received as well as rate of epinephrine dosing impacted acute kidney injury risk and severity of acute kidney injury.

Conclusions: This study is the first to identify risk factors for acute kidney injury in children after cardiac arrest. Our findings regarding the impact of epinephrine dosing are of particular interest and suggest potential for epinephrine toxicity with regard to acute kidney injury. The ability to identify and potentially modify risk factors for acute kidney injury after cardiac arrest may lead to improved morbidity and mortality in this population.

Supplemental Digital Content is available in the text.

1Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.

2Division of Nephrology, Hypertension, and Pheresis, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.

3Department of Surgery, Washington University School of Medicine, St. Louis, MO.

4Department of Political Science, Washington University School of Medicine, St. Louis, MO.

5Department of Biostatistics, Washington University School of Medicine, St. Louis, MO.

6Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

7Department of Neurology, Washington University School of Medicine, St. Louis, MO.

8Department of Pediatrics, University of Utah, Salt Lake City, UT.

9Division of Critical Care Medicine, Department of Pediatrics, CS Mott Children’s Hospital, University of Michigan, Ann Arbor, MI.

10Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO.

*See also p. 997.

This work was performed at Washington University School of Medicine, St. Louis, MO.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Dr. Gill received funding from Corning Corporation. Drs. Dean, Moler, and Doctor received support for article research from the National Institutes of Health (NIH). Dr. Dean’s institution received funding from the NIH. Dr. Moler’s institution received funding from the NIH/National Heart, Lung, and Blood Insititution and the NIH/National Institute of Child Health and Human Development. Dr. Doctor’s institution received funding from the NIH, the Department of Defense, and Children’s Discovery Institute. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: neumayr_t@wustl.edu

©2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies