Saskia N. De Wildt (Netherlands)
Radboudumc Pharmacology - ToxicologyAuthor Of 4 Presentations
DIAGNOSIS OF AKI USING IOHEXOL IN CRITICALLY ILL CHILDREN AND NEONATES: PRELIMINARY RESULTS OF THE HERO STUDY.
Abstract
Background and Aims
Up to 35% of all PICU and NICU patients will develop acute kidney injury (AKI), which is associated with a poor outcome and thus emphasizes the importance of an early diagnosis. However, this prevalence is based on estimation of GFR (eGFR) using serum creatinine, which is known to be inaccurate and may reflect an overestimation of GFR in this population. We aimed to test our hypothesis that AKI prevalence will be higher in critically ill children when using measured GFR (mGFR) based on iohexol clearance, than using eGFR and to investigate agreement between methods.
Methods
Term-born neonates and children admitted to the ICU with at least one failing organ were included. mGFR was calculated using a plasma disappearance curve after injection of iohexol. In parallel, eGFR was estimated using the bedside Schwartz equation (40*height(cm)/serum creatinine(µmol/L). Patients were diagnosed with AKI when serum creatinine, eGFR or mGFR values exceeded mean age specific reference values +1SD or were below 150% of the median, respectively. Agreement between methods was determined using Bland-Altman-Plots.
Results
Nineteen neonates (median age 2(range 1-21)days) and 21 children (8(0-17)years) were included. mGFR based diagnosis did not lead to a higher prevalence of AKI. Yet, prevalences varied greatly among PICU and NICU patients and between used methods (range 5.3-47.7%). Bland-Altman plots show moderate agreement between mGFr and eGFR(figure1).
Conclusions
When using iohexol based mGFR, the prevalence of AKI was not higher compared to eGFR based prevalence in our population. However, AKI appears very prevalent in PICU but less in term NICU patients.