Childhood Acute Renal Failure: 22-Year Experience in a University Hospital in Southern Thailand

Vachvanichsanong, Prayong; Dissaneewate, Pornsak; Lim, Apiradee; McNeil, Edward

doi:10.1542/peds.2006-0557

Cited by 144 publications

(129 citation statements)

References 17 publications

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“…incidences; rates of 17.9%-52% have been seen in the ICU or after corrective cardiac surgery (5,9,32). However, our findings are comparable with those findings of a single-center study, which used similar diagnostic criteria (4.6-9.9 per 1000 hospitalizations) (2). The large scale of our study allowed identification of novel AKI demographics in children.…”

Section: Discussionsupporting

confidence: 85%

“…Most pediatric studies have been from single centers and are limited by small sample size and a propensity to focus only on critical care populations or children who require dialysis (2,(14)(15)(16)(17)(18)(19)(20)(21)(22). Studies have suggested that the epidemiology of pediatric AKI has changed dramatically over the past few decades, noting that sepsis, congenital heart disease, and oncologic illness have replaced hemolytic uremic syndrome, GN, and primary renal diseases as the most common causes of AKI in hospitalized children (14,23).…”

Section: Introductionmentioning

confidence: 99%

“…Studies have suggested that the epidemiology of pediatric AKI has changed dramatically over the past few decades, noting that sepsis, congenital heart disease, and oncologic illness have replaced hemolytic uremic syndrome, GN, and primary renal diseases as the most common causes of AKI in hospitalized children (14,23). However, this assertion has been based primarily on anecdotal evidence and analysis of small AKI subsets (2,20,21).…”

Section: Introductionmentioning

confidence: 99%

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AKI in Hospitalized Children

Sutherland

Ji²,

Sheikhi³

et al. 2013

Clinical Journal of the American Society of Nephrology

229

154

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SummaryBackground and objectives Although AKI is common among hospitalized children, comprehensive epidemiologic data are lacking. This study characterizes pediatric AKI across the United States and identifies AKI risk factors using high-content/high-throughput analytic techniques.Design, setting, participants, & measurements For the cross-sectional analysis of the 2009 Kids Inpatient Database, AKI events were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Demographics, incident rates, and outcome data were analyzed and reported for the entire AKI cohort as well as AKI subsets. Statistical learning methods were applied to the highly imbalanced dataset to derive AKI-related risk factors.Results Of 2,644,263 children, 10,322 children developed AKI (3.9/1000 admissions). Although 19% of the AKI cohort was #1 month old, the highest incidence was seen in children 15-18 years old (6.6/1000 admissions); 49% of the AKI cohort was white, but AKI incidence was higher among African Americans (4.5 versus 3.8/1000 admissions). In-hospital mortality among patients with AKI was 15.3% but higher among children #1 month old (31.3% versus 10.1%, P,0.001) and children requiring critical care (32.8% versus 9.4%, P,0.001) or dialysis (27.1% versus 14.2%, P,0.001). Shock (odds ratio, 2.15; 95% confidence interval, 1.95 to 2.36), septicemia (odds ratio, 1.37; 95% confidence interval, 1.32 to 1.43), intubation/mechanical ventilation (odds ratio, 1.2; 95% confidence interval, 1.16 to 1.25), circulatory disease (odds ratio, 1.47; 95% confidence interval, 1.32 to 1.65), cardiac congenital anomalies (odds ratio, 1.2; 95% confidence interval, 1.13 to 1.23), and extracorporeal support (odds ratio, 2.58; 95% confidence interval, 2.04 to 3.26) were associated with AKI.Conclusions AKI occurs in 3.9/1000 at-risk US pediatric hospitalizations. Mortality is highest among neonates and children requiring critical care or dialysis. Identified risk factors suggest that AKI occurs in association with systemic/multiorgan disease more commonly than primary renal disease.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

AKI in Hospitalized Children

Sutherland

Ji²,

Sheikhi³

et al. 2013

Clinical Journal of the American Society of Nephrology

229

154

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4] The incidence of AKI is high and continues to increase, 2,[5][6][7] which may lead to increasing prevalence of CKD, which in turn could create long-term burdens on patients and health care systems.…”

Section: (Continued On Last Page)mentioning

confidence: 99%

Administrative Data Misclassifies and Fails to Identify Nephrotoxin-Associated Acute Kidney Injury in Hospitalized Children

Schaffzin¹,

Dodd

Nguyen

et al. 2014

Hospital Pediatrics

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Objectives: Nephrotoxin exposure is a common cause of acute kidney injury (AKI) in hospitalized children. AKI detection relies on regular serum creatinine (SCr) screening among exposed patients. We sought to determine how well administrative data identify hospitalized noncritically ill children with nephrotoxic medication-associated AKI in the contexts of incomplete and complete screening. Methods: We conducted a single-center retrospective cohort study among noncritically ill hospitalized children. We compared administrative data sensitivity to that among a separate cohort for whom adequate screening was defined as daily SCr measurement. For the original cohort, nephrotoxin exposure was defined as exposure to ≥3 nephrotoxins at once or ≥3 days of aminoglycoside therapy. AKI was defined by the change in SCr (pediatric-modified Risk Injury Failure Loss End-Stage Renal Disease [pRIFLE] criteria) or discharge code. Adequate SCr screening was defined as 2 measurements obtained ≤96 hours apart. Administrative data and laboratory values were merged to compare AKI by discharge code and pRIFLE criteria. Results: 747 of 1472 (50.7%) nephrotoxin-exposed patients were adequately screened; 82 (11.0%) had AKI by pRIFLE criteria, 52 (7.0%) by discharge code. Sensitivity of nephrotoxin-associated AKI diagnosis by discharge code compared with pRIFLE criteria was 23.2% (95% confidence interval = 14.0–32.3). In the comparison cohort, 70 (26.8%) patients had AKI by pRIFLE criteria and 26 (10.0%) by discharge code; sensitivity was 21.4% (95% confidence interval = 11.8%–31.0%). Conclusions: pRIFLE criteria identified more patients than were identified by discharge code. Identifying patients with nephrotoxin-associated AKI by discharge code, even in the presence of complete AKI detection, underrepresents the true incidence of nephrotoxin-associated AKI in hospitalized children.

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“…Whereas in developed regions elderly patients predominate (4,5), in developing countries, AKI is a disease of the young (14,17,18) and children (19,20), in whom volume-responsive "prerenal" mechanisms are common (21)(22)(23)(24). Although overall mortality seems to be lower than in developed countries (25)(26)(27)(28), this finding is not true across all age groups: In these regions, AKI affects predominantly the young and children and mortality is high (29,30).…”

mentioning

confidence: 99%

Epidemiology of Acute Kidney Injury

Cerdá¹,

Lameire²,

Eggers³

et al. 2008

Clinical Journal of the American Society of Nephrology

247

156

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Background and objectives: The worldwide incidence of acute kidney injury is poorly known because of underreporting, regional disparities, and differences in definition and case mix. New definitions call for revision of the problem with unified criteria.Design, setting, participants, & measurements: This article reports on the research recommendations of an international multidisciplinary committee, assembled to define a research agenda on acute kidney injury epidemiology using a modified three-step Delphi process.Results: Knowledge of incidence and risk factors is crucial because it drives local and international efforts on detection and treatment. Also, notable differences exist between developing and developed countries: Incidence seems higher in the former, but underreporting compounded by age and gender disparities makes available data unreliable. In developing countries, incidence varies seasonally; incidence peaks cause critical shortages in medical and nursing personnel. Finally, in developing countries, lack of systematic evaluation of the role of falciparum malaria, obstetric mechanisms, and hemolytic uremic syndrome on acute kidney injury hampers efforts to prevent acute kidney injury.Conclusions: The committee concluded that epidemiologic studies should include (1) prospective out-and inpatient studies that measure incidence of community and hospital acute kidney injury and post-acute kidney injury chronic kidney disease; (2) incidence measurements during seasonal peaks in developing and developed countries; and (3) whenever available, use of reliable existing administrative or institutional databases. Epidemiologic studies using standardized definitions in community and institutional settings in developing and underdeveloped countries are essential first steps to achieving early detection and intervention and improved patient outcomes.

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Childhood Acute Renal Failure: 22-Year Experience in a University Hospital in Southern Thailand

Cited by 144 publications

References 17 publications

AKI in Hospitalized Children

AKI in Hospitalized Children

Administrative Data Misclassifies and Fails to Identify Nephrotoxin-Associated Acute Kidney Injury in Hospitalized Children

Epidemiology of Acute Kidney Injury

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