Using the KDIGO criteria to define AKI, we observed a high prevalence of AKI among critically ill children. Worsening stages of AKI were associated with increased ICU LOS, and AKI was independently associated with prolonged mechanical ventilation and increased mortality. The KDIGO criteria describe clinically relevant AKI in a broad pediatric critical care population.

The objective of this study was to evaluate the healthcare utilization of hospitalized children with hypertension. The Healthcare Cost and Utilization Project Kids' Inpatient Database, years 1997, 2000, 2003, and 2006, was used to identify hypertension hospitalizations. We examined the association of patient and hospital characteristics on hypertension charges. Data from each cohort year were used to analyze trends in charges. We found that 71282 pediatric hypertension hospitalizations generated $3.1 billion in total charges from 1997 to 2006. Approximately 68% were 10 to 18 years old, 55% were boys, and 47% were white. Six percent of claims with a diagnosis code for hypertension also had a diagnosis code for end-stage renal disease or renal transplant. The frequency of hypertension discharges increased over time (P=0.02 for each of age groups 2–9 years and 2–18 years; P=0.03 for age group 10–18 years), as well as the fraction of inpatient charges attributed to hypertension (P<0.0001). Length of stay and end-stage renal disease were associated with increases in hospitalization associated charges (P<0.0001 and P=0.03, respectively). During the 10-year study period, the frequency of hypertension-associated hospitalizations was increasing across all of the age groups, and the fraction of charges related to hypertension was also increasing. The coexisting condition of end-stage renal disease resulted in a significant increase in healthcare charges.

Objectives Reports of the burden of hypertension in hospitalized children are emerging, but the prevalence and significance of this condition within the pediatric intensive care unit (PICU) are not well understood. The aims of this study were to validate a definition of hypertension in the PICU and assess the associations between hypertension and acute kidney injury (AKI), PICU length of stay (LOS), and mortality. Design and Setting Single center retrospective study using a database of PICU discharges between July 2011 and February 2013. Patients All children discharged from the PICU with LOS > 6 hours, aged 1 month through 17 years. Exclusions were traumatic brain injury, incident renal transplant, or hypotension. Measurements and Main Results Potential definitions of hypertension utilizing combinations of standardized cutoff percentiles, durations, initiation or dose escalation of antihypertensives, and/or billing diagnosis codes for hypertension were compared using receiver operator characteristic curves against a manual medical record review. Multivariable logistic and linear regression analyses were conducted using the selected definition of hypertension to assess its independent association with AKI and PICU LOS, respectively. A definition requiring 3 systolic and/or diastolic readings above standardized 99th percentiles plus 5 mmHg over 1 day was selected (area under the curve 0.91, sensitivity 94%, specificity 87%). Among the 1,215 patients in this analysis, the prevalence of hypertension was 25%. Hypertension was independently associated with AKI (OR 2.89, 95% CI 1.64–5.09, P<0.01) and increased PICU LOS (1.50 days, 95% CI 0.94–2.05, P<0.01) in multivariable analyses. Deaths were rare—0 in the normotension group and 3 (1%) in the hypertension group—but were statistically different (P=0.02). Conclusions Hypertension is common in the PICU and is associated with worse clinical outcomes. Future studies are needed to confirm these results.