Association Between Progression and Improvement of Acute Kidney Injury and Mortality in Critically Ill Children*

Sanchez-Pinto, L. Nelson; Goldstein, Stuart L.; Schneider, James; Khemani, Robinder G.

doi:10.1097/pcc.0000000000000461

Cited by 79 publications

(65 citation statements)

References 30 publications

(39 reference statements)

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“…19–21 Previously reported rates of acute kidney injury among children and young adults vary widely — from 5% to 82%. 6,7,11,12,22 This variation probably results from differences in case mix, illness severity, coexisting conditions, and definitions of acute kidney injury. A 5% rate of acute kidney injury was reported in a single-center study that used a 100% rise in the plasma creatinine level to define acute kidney injury, 22 whereas in another study, 82% of patients receiving at least one vasoactive medication and mechanical ventilation had acute kidney injury as defined by a 33% rise in the plasma creatinine level.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults

et al. 2017

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Background The epidemiologic characteristics of children and young adults with acute kidney injury have been described in single-center and retrospective studies. We conducted a multinational, prospective study involving patients admitted to pediatric intensive care units to define the incremental risk of death and complications associated with severe acute kidney injury. Methods We used the Kidney Disease: Improving Global Outcomes criteria to define acute kidney injury. Severe acute kidney injury was defined as stage 2 or 3 acute kidney injury (plasma creatinine level ≥2 times the baseline level or urine output <0.5 ml per kilogram of body weight per hour for ≥12 hours) and was assessed for the first 7 days of intensive care. All patients 3 months to 25 years of age who were admitted to 1 of 32 participating units were screened during 3 consecutive months. The primary outcome was 28-day mortality. Results A total of 4683 patients were evaluated; acute kidney injury developed in 1261 patients (26.9%; 95% confidence interval [CI], 25.6 to 28.2), and severe acute kidney injury developed in 543 patients (11.6%; 95% CI, 10.7 to 12.5). Severe acute kidney injury conferred an increased risk of death by day 28 after adjustment for 16 covariates (adjusted odds ratio, 1.77; 95% CI, 1.17 to 2.68); death occurred in 60 of the 543 patients (11.0%) with severe acute kidney injury versus 105 of the 4140 patients (2.5%) without severe acute kidney injury (P<0.001). Severe acute kidney injury was associated with increased use of mechanical ventilation and renal-replacement therapy. A stepwise increase in 28-day mortality was associated with worsening severity of acute kidney injury (P<0.001 by log-rank test). Assessment of acute kidney injury according to the plasma creatinine level alone failed to identify acute kidney injury in 67.2% of the patients with low urine output. Conclusions Acute kidney injury is common and is associated with poor outcomes, including increased mortality, among critically ill children and young adults. (Funded by the Pe-diatric Nephrology Center of Excellence at Cincinnati Children’s Hospital Medical Center and others; AWARE ClinicalTrials.gov number, NCT01987921.)

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Section: Discussionmentioning

confidence: 99%

Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults

et al. 2017

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“…The 28-day ICU mortality was 2.7 % for patients with no AKI and 25.3 % for patients with AKI. Progression of AKI was independently associated with increased mortality in the PICU, while its improvement was associated with a stepwise decrease in mortality [23].…”

Section: Aki In Critically Ill Childrenmentioning

confidence: 94%

“…Similarly, as in adult studies, higher pRIFLE stages are associated with unfavorable outcomes [22]. To the contrary, Sanchez-Pinto et al [23] recently used the KDIGO AKI staging criteria in a heterogeneous pediatric intensive care unit (PICU) population to analyze the dynamic change in severity of AKI. An independent association between the development, progression, and improvement of AKI and mortality was found even after controlling for severity of illness and other organ dysfunctions.…”

Section: Introductionmentioning

confidence: 97%

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

2016

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In this review we summarize the world-wide epidemiology of acute kidney injury (AKI) in children with special emphasis on low-income countries, notably those of the sub-Saharan continent. We discuss definitions and classification systems used in pediatric AKI literature. At present, despite some shortcomings, traditional Pediatric Risk Injury Failure Loss and End Stage Kidney Disease (pRIFLE) and Kidney Disease Improving Global Outcomes (KDIGO) systems are the most clinically useful. Alternative definitions, such as monitoring serum cystatin or novel urinary biomarkers, including cell cycle inhibitors, require more long-term studies in heterogenous pediatric AKI populations before they can be recommended in routine clinical practice. A potentially interesting future application of some novel biomarkers could be incorporation into the "renal angina index", a concept recently introduced in pediatric nephrology. The most reliable epidemiological data on AKI in children come from high-outcome countries and are frequently focused on critically ill pediatric intensive care unit populations. In these patients AKI is often secondary to other systemic illnesses or their treatment. Based on a recent literature search performed within the framework of the "AKI 0by25" project of the International Society of Nephrology, we discuss the scarce and often inaccurate data on AKI epidemiology in low-income countries, notably those on the African continent. The last section reflects on some of the many barriers to improvement of overall health care in low-income populations. Although preventive strategies for AKI in low-income countries should essentially be the same as those in high-income countries, we believe any intervention for earlier detection and better treatment of AKI must address all health determinants, including educational, cultural, socio-economic and environmental factors, specific for these deprived areas.

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“…[19][20][21] Previously reported rates of acute kidney injury among children and young adults vary widely -from 5% to 82%. 6,7,11,12,22 This variation probably results from differences in case mix, illness severity, coexisting conditions, and definitions of acute kidney injury. A 5% rate of acute kidney injury was reported in a single-center study that used a 100% rise in the plasma creatinine level to define acute kidney injury, 22 whereas in another study, 82% of patients receiving at least one vasoactive medication and mechanical ventilation had acute kidney injury as defined by a 33% rise in the plasma creatinine level.…”

Section: Discussionmentioning

confidence: 99%

“…5 In comparison, the study of acute kidney injury in children has been limited. [6][7][8][9] Four single-center, retrospective studies involving children have used the KDIGO criteria, [10][11][12][13] but none of those assessed urine output in the diagnosis of acute kidney injury.…”

mentioning

confidence: 99%