Acute kidney injury in children: incidence, awareness and outcome – a retrospective cohort study (original) (raw)
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Incidence of Acute Kidney Injury and Determinant Factors in Children Admitted to a Tertiary Hospital
acute kidney injury is common in hospitalized children and this study characterizes acute kidney injury in hospitalized children in a tertiary care center. Identify the incidence and risk factors of acute kidney injury in hospitalized children. The study is prospective, institution based and observational. During the study period, 5348 children were admitted among which 68 children developed AKI with an incidence rate of 12.7/1000 admissions. Severe AKI was 64.7%. The mortality rate with AKI was 26.5% when compared with 8.7% without AKI. Age 5-14 years had a 1.2 times higher risk of developing AKI than children under five years (adjusted HR 1.22; 95% CI, 0.74-2.98). Females had 2.8 times higher risk of developing AKI (adjusted HR 2.79; 95% CI, 1.29-6.02) than males. Children with heart failure, malignant diseases and sepsis had 3.7, 4.5 and 8.0 times higher risk of developing AKI than other diagnosis respectively with (AHR 3.74; 95% CI, 1.34-10.4), (AHR 4.50; 95% CI, 1.78-11.4) and (AHR 8.09, 95% CI, 1.88-34.8) respectively. Children with severe AKI had the highest mortality AHR 2.68, 95% CI (0.96, 7.47) when compared with non-severe AKI AHR 0.85, 95% CI (0.20, 3.56). AKI is common in hospitalized children and it is a significant cause of mortality.
Outcome of pediatric acute kidney injury: a multicenter prospective cohort study
Pediatric Nephrology, 2017
Background Acute kidney injury (AKI) is a common problem encountered in critically ill children with an increasing incidence and evolving epidemiology. AKI carries a serious morbidity and mortality in patients requiring admission to a pediatric intensive care unit (PICU). Methods We undertook a prospective cohort study of PICU admissions at three tertiary care hospitals in the Kingdom of Saudi Arabia over 2 years. The Kidney Disease Improving Global Outcomes (KDIGO) definition was used to diagnose AKI. Results A total of 1367 pediatrics PICU admissions were included in the study. AKI affected 511 children (37.4%), with 243 children (17.8%) classified as stage I (mild), 168 patients (12.3%) stage II (moderate), and 100 children (7.3%) were classified as stage III (severe). After adjustment for age, sex, and underlying diagnosis, in-hospital mortality was six times more likely among patients with AKI as compared to patients with normal renal function (adjusted OR: 6.5, 95% CI: 4.2-10). AKI was also a risk factor for hypertension (adjusted OR: 4.1, 95% CI: 2.8-5.9) and prolonged stay in the PICU and hospital, as it increased the average number of admission days by 10 (95% CI: 8.6-11) days in the PICU and 12 (95% CI: 10-14) days in the hospital. Conclusions One-third of PICU admissions were complicated with AKI. AKI was associated with increased hospital mortality and the length of stay in both PICU and hospital.
Acute kidney injury in children
Pediatric Nephrology, 2009
Acute kidney injury (AKI) (previously called acute renal failure) is characterized by a reversible increase in the blood concentration of creatinine and nitrogenous waste products and by the inability of the kidney to regulate fluid and electrolyte homeostasis appropriately. The incidence of AKI in children appears to be increasing, and the etiology of AKI over the past decades has shifted from primary renal disease to multifactorial causes, particularly in hospitalized children. Genetic factors may predispose some children to AKI. Renal injury can be divided into prerenal failure, intrinsic renal disease including vascular insults, and obstructive uropathies. The pathophysiology of hypoxia/ischemia-induced AKI is not well understood, but significant progress in elucidating the cellular, biochemical and molecular events has been made over the past several years. The history, physical examination, and laboratory studies, including urinalysis and radiographic studies, can establish the likely cause(s) of AKI. Many interventions such as 'renal-dose dopamine' and diuretic therapy have been shown not to alter the course of AKI. The prognosis of AKI is highly dependent on the underlying etiology of the AKI. Children who have suffered AKI from any cause are at risk for late development of kidney disease several years after the initial insult. Therapeutic interventions in AKI have been largely disappointing, likely due to the complex nature of the pathophysiology of AKI, the fact that the serum creatinine concentration is an insensitive measure of kidney function, and because of co-morbid factors in treated patients. Improved understanding of the pathophysiology of AKI, early biomarkers of AKI, and better classification of AKI are needed for the development of successful therapeutic strategies for the treatment of AKI.
Acute Kidney Injury In Children Admitted In Pediatric Intensive Care Unit
Pediatric Sciences Journal
Background: Acute kidney injury (AKI) poses a significant burden for the society, in terms of health resource use during the acute phase, and the potential long-term sequelae including development of chronic kidney disease and kidney failure. Aim of the work: to investigate the risk of development of AKI in critically ill children. Material and methods: A cohort study conducted on 60 critically ill children admitted at pediatric intensive care unit (PICU). They were divided into two groups according to hemodynamic stability. Cardiovascular parameters together with criteria for AKI were observed during the first 5 days of PICU admission. AKI was diagnosed based on Acute Kidney Injury Network criteria. Results: From all critically ill included patients (60 patients); thirty four patients developed AKI (56.6%). Frequency of AKI was significantly more in hemodynamically unstable than stable patients 22 (73%) versus 12 (40%) (p=0.018). AKI was strongly associated with decreased baseline systolic and diastolic blood pressure percentiles (p=0.04) and (p=0.049), increased doses and duration of inotropic support determined by vasoactive inotropic score (p=0.002) and (p=0.013) respectively, higher base deficit in baseline blood gases (p=0.002), multiple organ dysfunctions (p<0.001) and exposure to nephrotoxic agents (p=0.036). Conclusion: AKI is a common morbidity among hemodynamically unstable critically ill children. AKI is strongly associated with initial hypotension on admission, increased doses and longer duration of inotropic support, increased base deficit in initial blood gases evaluation, multiple organ dysfunctions and exposure to nephrotoxic agents.
Pediatric Research
BACKGROUND: Hospital-acquired acute kidney injury (HA-AKI) is associated with an increased risk of childhood mortality; however, only a few studies have addressed communityacquired AKI (CA-AKI). METHODS: AKI network classification was used to assess CAand HA-AKI, 2010-2014. Patients with CA-AKI who were admitted to an inpatient setting were categorized as CAA-AKI. CANA-AKI was for CA-AKI not admitted to inpatient care. Epidemiology, factors associated with AKI, and in-hospital outcomes were assessed for variation. RESULTS: Prevalence of CANA-AKI was 4/1,000 outpatient visits, 17/1,000 hospital admissions for CAA-AKI, and 9.69/1,000 hospital admissions for HA-AKI. Mortality was higher among AKI patients (HA-AKI, 13.64%; CAA-AKI, 3.7%) than in no-AKI patients (0.57%). Patients with AKI and those with severe stages of AKI resulted in an increase in health-care service utilization (both Po0.001). Prior renal disease and recent hospitalization were associated with pediatric AKI in both outpatient and inpatient settings. Hematological malignancies, congenital anomalies, circulatory disease, and nephrotoxic medication use were associated with AKI, although the extent of associations varied slightly by setting. CONCLUSION: Increasing incidence of AKI in the community emphasizes the need for an increased awareness of AKI among health professionals to identify at-risk children and monitor SCr, so that modifiable risk factors can be managed.
#6039 Epidemiology and Outcomes of Acute Kidney Injury: Don't Forget the Children
Nephrology Dialysis Transplantation
Background and Aims Acute kidney disease (AKI) has evolved from a primary single renal disease to a syndrome secondary to other systemic illness. The aim of this study is to asses AKI epidemiology in a large East European country database comprising a mixt paediatric population (critically ill and non-critically ill) and the impact on mortality and hospitalization length. Method We conducted a retrospective observational study on all the admitted paediatric patients from 1 day to 18 years old between first of January 2014 until 31 December 2021. Out of 137760 admissions, 2194 patients were included in the study. We classified the different age groups as: premature (all the babies born before 37 weeks of gestation), full-term new-borns, infants (between 28 days and 12 months of life), toddlers (over 12 months up to 3 years), pre-schoolers (between 3 and 5 years), scholars (6 years to 11 years) and adolescents (12 to 18 years). Results The overall incidence of AKI was 15.92/1000 hospi...
Pediatric Review: International Journal of Pediatric Research
Aim/Objectives: To study the incidence, clinical-profile of AKI developing in critically-ill children after admission to PICU, including its risk-factors and determinants affecting patient outcome. Material/Methods: This prospective observational study was conducted at a tertiary teaching hospital (Pt JNM Medical College Raipur, CG, India) over a study period of 12 months (August 2017-July 2018). Those patients who satisfied the inclusion-criteria of having criticalillness requiring PICU admission, age between 1month to 18 years, and developing in-hospital AKI were enrolled; and after obtaining written informed-consent from parents, their basic demographic, clinical details and laboratory reports were entered from case records into predesigned proforma and then data was compiled in Microsoft Excel-Sheet. AKI staging was obtained using pRIFLE criteria (2007) and compared with renal-recovery and patient-survival. SPSS software (version 21) was used for data-analysis and p-value <0.05 was taken for statistical significance. Results: Out of total 1042 critically-ill children admitted during study-period, 103 developed new-onset AKI in PICU (overall incidence 9.8%). Among them, 96 patients died (93.2% cases). Maximum subjects developing in-hospital AKI had three major associated fatal risk-factors like refractory shock (80.5%), severe sepsis (68%) and MODS (62.1%). But only MODS (p=0.002) and refractory-shock (p=0.0001) showed significant association with fatal outcome. Maximum new-onset AKI cases developed within 3 days of PICU admission (62%). No statistically-significant association was observed between different AKI-stages and renal-recovery or patient-survival. Conclusion: Sepsis was common underlying risk-factor for new-onset AKI in critically-ill patients admitted in PICU, while association of MODS and/or refractory shock majorly determined poor survival-outcome.
Etiology, Clinical Profile, and Short-Term Outcome of Children With Acute Kidney Injury
Cureus, 2022
Background: Acute kidney injury (AKI) is a common clinical syndrome in hospitalized children and it imposes heavy burden of mortality and morbidity. In resource-constraint settings, management of AKI is very challenging and associated with adverse outcomes. The aim of this study was to determine the clinico-etiological profile and outcome of AKI. Methodology: This prospective observational study was done at the department of pediatric nephrology and pediatric intensive care unit, National Institute of Child Health, Karachi, Pakistan from December 2020 to May 2021. A total of 130 children aged 1 month to 15 years, diagnosed with AKI irrespective of the underlying cause were included. Detailed medical information of each child including medical history, examination, and baseline investigations were obtained. Clinical and etiological profile of patients was noted. The patients were followed up to three months and the outcome was noted. Results: In a total of 130 children, 82 (63.1%) we...
Acute Kidney Injury in Critically Ill Children and Subsequent Chronic Kidney Disease
Canadian journal of kidney health and disease, 2019
Background: The progression from acute kidney injury (AKI) to chronic kidney disease (CKD) is not well understood in children. Objectives: We aimed to develop a pediatric CKD definition using administrative data and use it to evaluate the association between AKI in critically ill children and CKD 5 years after hospital discharge. Design: Retrospective cohort study using chart collection and administrative data. Setting: Two-center study in Montreal, Canada. Patients: Children (≤18 years old) admitted to two pediatric intensive care units (ICUs) between 2003 and 2005. We a priori excluded patients with end-stage renal disease or no health care number. Only the first admission during the study period was included. We excluded patients who could not be linked to administrative data, did not survive hospitalization, or had preexisting renal disease. Measurements: Acute kidney injury was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patients were defined as having CKD 5 years post-discharge if they had ≥1 CKD diagnostic code or ≥1 CKD-specific medication prescription. Methods: Chart data used to define the exposure (AKI) were merged with provincial administrative data used to define the outcome (CKD). Cox regression was used to evaluate the AKI-CKD association. Results: A total of 2235 (56% male) patients were included, and the median admission age was 3.7 years. A total of 464 (21%) patients developed AKI during pediatric ICU admission. At 5 years post-discharge, 43 (2%) patients had a CKD diagnosis. Patients with both stage 1 and stage 2-3 AKI had increased risk of a CKD diagnosis, with the adjusted hazard ratios (95% confidence intervals) of 2.2 (1.1-4.5) and 2.5 (1.1-5.7), respectively (P < .001). Limitations: Results may not be generalizable to non-ICU patients. We were not able to control for post-discharge variables; future research should try to explore these additional potential risk factors further. Conclusions: Acute kidney injury is associated with 5-year post-discharge CKD diagnosis defined by administrative health care data. Abrégé Contexte: Chez l'enfant, la progression de l'insuffisance rénale aigüe (IRA) vers l'insuffisance rénale chronique (IRC) est encore mal connue. Objectifs: Nous souhaitions élaborer une définition de l'IRC pédiatrique à partir des données administratives, et l'employer pour évaluer l'association entre l'IRA chez les enfants gravement malades et un diagnostic d'IRC cinq ans après leur sortie de l'hôpital. Type d'étude: Étude de cohorte rétrospective réalisée à partir des dossiers médicaux et des données administratives. Cadre: Deux centres hospitaliers de Montréal (Canada). Sujets: L'étude porte sur des enfants (≤18 ans) admis à deux unités de soins intensifs (USI) pédiatriques entre 2003 et 2005. Les patients atteints d'insuffisance rénale terminale ou sans numéro d'assurance-maladie ont été exclus d'emblée. Seule la première admission survenue au cours de l'étude a été retenue. Les patients n'ayant pu être reliés aux données administratives, n'ayant pas survécu à l'hospitalisation ou souffrant d'une néphropathie préexistante ont été exclus. Mesures: L'IRA a été définie selon les critères KDIGO (Kidney Disease: Improving Global Outcomes) et l'IRC cinq ans après la sortie de l'hôpital par la présence d'au moins un code diagnostique pour l'IRC ou la prise d'au moins un médicament spécifique au traitement de l'IRC.