Acute Kidney Injury among Hospitalized Children in China

Abstract

Background and objectives High-quality epidemiologic data on AKI in children are particularly lacking in developing countries. This study aimed to assess the epidemiology and clinical correlates of AKI among hospitalized children in China. Design, setting, participants, & measurements We performed a multicenter study, in a cohort of hospitalized children aged 1 month to 18 years, from 25 general and children's hospitals in China during 2013-2015. We obtained patient-level data from the electronic hospitalization information system and laboratory databases of all children who had at least two serum creatinine tests within any 7-day window during their first 30 days of hospitalization. We identified AKI events according to the creatinine criteria of Kidney Disease Improving Global Outcomes. The in-hospital outcomes of AKI, including mortality, kidney recovery, and length of stay, were assessed. We estimated the corresponding hazard ratios using a Cox proportional hazard model, with adjustment for age, sex, comorbidities, and clinical procedures. Results A total of 19,908 (20%) patients with AKI were identified among 101,836 pediatric inpatients, of which 7220 (7%) were community acquired and 12,688 (13%) were hospital acquired. Up to 96% of these AKI events were not diagnosed on the discharge records. The cumulative incidence of AKI in infants (28%) was twice that in adolescents (12%). The profiles of risk factors differed between community-acquired and hospital-acquired AKI and varied with age. Diarrhea and sepsis were the top risk factors for community-acquired AKI, each contributing 6% of the risk. Congenital heart disease/cardiac surgery was the major risk factor for hospital-acquired AKI, contributing to 19% of cases. Exposure to nephrotoxic drugs, mostly nonsteroidal anti-inflammatory drugs and proton pump inhibitors, was common in hospitalized children and was associated with a higher risk of AKI. Death occurred in 842 out of 19,908 patients (4%) with AKI versus 450 out of 81,478 children (0.5%) without AKI. The risk of in-hospital death was higher among children with severe AKI, shock, and respiratory failure. Pediatric AKI was associated with longer hospital stay and higher daily cost, even after adjustment for covariates.

Be aware of acute kidney injury in critically ill children with COVID-19

“…The AWARE (Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology) study, which enrolled ICUs in 32 hospitals in Asia, Australia, Europe, and North America, showed that the overall incidence of AKI in 4683 critically ill children was 26.9%, and the incidence of severe AKI (KDIGO stage 2 or 3) was 11.6% [ 8 , 14 ]. Another multi-center study reported an incidence of AKI of 20% in the total 101,836 pediatric inpatients from 25 centers in China [ 15 ], where AKI occurred in 49.1% of children with respiratory failure. In our cohort, the incidence of AKI in pediatric patients with COVID-19 was 1.2% (3/238), much less common than in adults.…”

Big Data and Pediatric Acute Kidney Injury: The Promise of Electronic Health Record Systems

“…Interestingly, this study highlighted the fact that much AKI in adults is community acquired which cannot be addressed using most EHR-enabled prediction models. While this is true in adult populations, pediatric AKI tends to be hospital rather than community acquired (48,49). Thus, it is possible that pediatric populations will benefit more substantially from predictive models.…”

The diagnostic value of combined indexes in Acute Renal injury after Cardiopulmonary Bypass Surgery in infants with Congenital Heart Disease

“…Previous studies on AKI have mostly focused on adult and adolescent patients [19][20][21], and the investigation and study to evaluate the acute kidney injury of infants after operation are relatively rare,complications, hospitalization expenses and other adverse consequences of AKI in hospitalized infants are no less than those of adults, and the physiological regulation function of infants's own organs is worse than that of adults, which often results in worse prognosis than adults [22,23]. For this reason, researchers have made appropriate improvements in the diagnosis and treatment of AKI in infants with congenital heart diseases compared with adults, and tried to find more sensitive and accurate markers to monitor the occurrence and development of AKI in infants [24,25].…”