Acute Kidney Injury Incidence in Noncritically Ill Hospitalized Children, Adolescents, and Young Adults: A Retrospective Observational Study

Abstract

Background Acute kidney injury (AKI) has been characterized in young high-risk inpatients, in whom AKI is frequent and associated with increased mortality, morbidity, and length of stay. The incidence of AKI among patients not requiring intensive care is unknown. Study Design Retrospective cohort study Setting & Participants 13,914 noncritical admissions during 2011–2012 at our tertiary referral pediatric hospital were evaluated. Patients <28 days or >21 years of age, or with chronic kidney disease (CKD), were excluded. Admissions with ≥2 serum creatinine measurements were evaluated. Factors Demographic features, laboratory measurements, medication exposures, and length of stay. Outcome AKI defined by increased serum creatinine in accordance with KDIGO (Kidney Disease: Improving Global Outcomes) criteria. Based on time of admission, time interval requirements were met in 97% of cases, but KDIGO time window criteria were not strictly enforced to allow implementation using clinically-obtained data. Results Two or more creatinine measurements (one baseline before or during admission, and a second during admission) in 2,374 of 13,914 (17%) patients allowed for AKI evaluation. A serum creatinine difference of ≥0.3 mg/dL or ≥1.5 times baseline was seen in 722 of 2,374 (30%) patients. A minimum of 5% of all noncritical inpatients without CKD in pediatric wards have an episode of AKI during routine hospital admission. Limitations Urine output, glomerular filtration rate, and time interval criteria for AKI were not applied secondary to study design and available data. The evaluated cohort was restricted to patients with ≥2 clinically obtained serum creatinine measurements, and baseline creatinine may have been measured after the AKI episode. Conclusions AKI occurs in at least 5% of all non-critically ill hospitalized children, adolescents, and young adults without known CKD. Physicians should increase their awareness of AKI and improve surveillance strategies with serum creatinine measurements in this population so that exacerbating factors such as nephrotoxic medication exposures may be modified as indicated.

Epidemiology of acute kidney injury in children worldwide, including developing countries

“…In contrast with the U.S. data just described [74], nephritic syndromes were the major specific cause (44 %) of AKI, followed by hemolytic-uremic syndrome (15 %).…”

“…A more recent U.S. study [74] calculated the AKI frequency over a 2-year period in a tertiary care children's hospital using KDIGO SCr criteria. The results show that a minimum of 5 % of all non-critical inpatients without chronic kidney disease (CKD) in pediatric wards have an episode of AKI during routine hospital admission.…”

Factors that influenced undergoing renal replacement therapy and survival in children with acute kidney injury

“…The pooled incidence rates of AKI in the world is found as high as 33.7% in all hospitalized children . A minimum of 5% of non‐critically ill hospitalized patients have AKI during their admission . Postcardiac surgery, sepsis, multiorgan failure, haemato‐oncological diseases, trauma, and exposure to nephrotoxic agents are the main causes of AKI in the critically ill child, while in the hospitalized non‐critically ill child, exposure to nephrotoxins is a major cause of AKI .…”

Drug-associated acute kidney injury: who’s at risk?

“…An overwhelming number of studies in both the pediatric and adult literature have shown that patients who develop AKI, from any cause, have increased hospital length of stay, increased hospital cost, and higher mortality compared to those who do not develop AKI [10, 13, 14, 21–24, 60–62]. In a recent study assessing critically ill children, mortality was almost nine times higher for children who developed AKI compared with those who didn’t, with a stepwise increase in mortality across KDIGO AKI stage [1], highlighting the clear need for further research regarding prevention and treatment of this disease.…”