Acute Kidney Injury Due to Diarrheal Illness Requiring Hospitalization: Data from the National Inpatient Sample

Abstract

Acute kidney injury is common and consequential among patients hospitalized for diarrheal illness. Persons with CKD and hypertension are the most susceptible, possibly due to diminished renal reserve and exacerbating effects of treatment with diuretics and renin-angiotensin-aldosterone system blockers. Proactive management of these unique pharmacologic and physiologic factors is necessary to prevent AKI in this vulnerable population.

Acute Kidney Injury in Children Hospitalized With Diarrheal Illness in the United States

“…Despite its rarity, the clinical consequences of AKI in this setting are dire: the odds of death are increased by eightfold, mean hospital stay is prolonged by ∼3 days, and costs are increased by .$9000 per hospital stay. We found that several comorbid conditions, including type of diarrhea (infectious versus noninfectious), previous solid organ transplant, hypertension, CKD, and rheumatologic and hematologic conditions When compared with adults, AKI complicating pediatric hospitalized diarrheal illness in the United States is much less common (incidence of ,1% vs 10% in children and adults, respectively), 13 although the incidence of AKI in our study is consistent with published findings on the national incidence of AKI in pediatric hospitalizations. 9,23,24 AKI had more pronounced effects on in-hospital mortality, LOS, and hospital costs for children hospitalized with diarrheal illness than it did in adults.…”

“…9,23,24 AKI had more pronounced effects on in-hospital mortality, LOS, and hospital costs for children hospitalized with diarrheal illness than it did in adults. 13 In previous studies, authors note worse AKIrelated health outcomes in younger, compared with older, patients experiencing AKI. 13,25,26 It is theorized that AKI, which develops in individuals with better baseline renal reserve, may reflect more severe underlying illness.…”

“…13 In previous studies, authors note worse AKIrelated health outcomes in younger, compared with older, patients experiencing AKI. 13,25,26 It is theorized that AKI, which develops in individuals with better baseline renal reserve, may reflect more severe underlying illness. 25,26 Although younger age has been associated with worse AKI-related hospital outcomes, we found that older children experienced a higher likelihood of developing AKI in hospitalized diarrheal illness.…”

“…We stratified our analyses by type of diarrheal illness (infectious or noninfectious) because we hypothesized that risk factors for development of AKI would differ on the basis of the underlying pathology. 13 For infectious diarrhea, we used the following ICD-9-CM diagnosis codes: 001, 002, 003.0, 004, 005, 006.0 to 006.2, 006.8 to 006.9, 007, 008, 009, 112.85, and 487.8. For noninfectious diarrhea, ICD-9-CM diagnosis codes included 271.3, 306.4, 536.8, 555, 556, 557, 558, 562.01, 562.03, 562.11, 562.13, 564.1 to 564.2, 564.4 to 564.5, 564.9, and 579; we excluded the code for diarrhea not otherwise specified (787.91) because it comprised ,5% of all admissions for diarrheal illness.…”

“…We selected a priori comorbidities of interest using ICD-9-CM diagnosis codes and grouping by organ system. 8,13,19 In Supplemental Table 5, we provide the ICD-9-CM, codes used to create comorbidity definitions as well as grouping of comorbidities into an organ system. Hospital-level variables included geographic region, bed number, and teaching status by using predetermined KID definitions.…”