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Abstract PD-027: COMPARISON OF THE P-RIFLE AND AKIN CRITERIA FOR IDENTIFICATION OF ACUTE KIDNEY INJURY IN PEDIATRIC DIABETICKETOACIDOSIS

Rameshkumar, R.1; Praveen, K.1; Satheesh, P.1; Jain, P.1; Bhowmick, R.1; Soundravally, R.2

Pediatric Critical Care Medicine: June 2018 - Volume 19 - Issue 6S - p 37
doi: 10.1097/01.pcc.0000537429.89653.34
Poster Discussion Abstracts
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1Jawaharlal Institute of Postgraduate Medical Education and Research JIPMER, Pediatrics, Puducherry, India

2Jawaharlal Institute of Postgraduate Medical Education and Research JIPMER, Biochemistry, Puducherry, India

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Aims & Objectives:

To compare the classifications of (p-RIFLEand AKIN) for predicting AKI in pediatric DKA.

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Methods

Setting: Pediatric Critical Care Division of a tertiary care institute. Subjects: Children aged ≤14 years with DKA as per ISPAD-2014 guideline. Intervention: Analyzed the prospectively collected data of 69 patients managed between Oct-2014 to April-2017. AKI presence and severity was assessed for each classification using the change in serum creatinine and estimated creatinine clearance (eCCl) levels calculated by the modified-Schwartz formula (=0.413xLength in cm / SCr in mg/dl). For baseline eCCl, the lowest value of SCr in the preceding 3-month of admission, if not, eCCl assigned of 100 ml/min/1.73m2.

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Results

Mean±SD of age was 99 ± 45 months and male:female is 20:49. Mild, moderate and severe DKA was present in 20 (29%),20 (29%) and 29 (42%) respectively. AKI was present in 64 (93%; R48%,I42%,F3%) and 59 (86%; I41%,II26%,III19%) according to p-RIFLE and AKIN criteria respectively. Intraclass correlation between two system for identification and the severity of AKI was 91%(95%CI 86% to 94%, p< 0.001). According to the severity of DKA, identification of AKI was similar between the p-RIFLE and AKIN (mild 80% vs.70%; moderate 100% vs. 95% and severe 97% vs. 90%). No difference in mean±SD time to resolution of DKA in p-RIFLE(25.4 ± 18.6 vs. 19.6 ± 5.2;p=0.099) and AKIN (21.3 ± 6.5 vs. 25.6 ± 19.2; p=0.196) criteria among AKI versus no AKI patients.

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Conclusions

p-RIFLE and AKIN criteria show excellent consistency in the identification of AKI in pediatric DKA. p-RIFLE shows early detection of AKI and AKIN shows over diagnosis of the severe type of AKI.

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies