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

Abstract

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.)

Risk Factor of Mortality in Indonesian Children with Cerebral Palsy

“…Severe AKI occurred in 543 (11.6%) patients and is related to an increased risk of death by day 28, increased use and duration of mechanical ventilation and renal replacement therapy. Respiratory and neurologic disorders stood out as the first (38.7%) and second (35.2%) most common co-existing conditions in the critically ill children in this study (15). Therefore, it fits the pattern of AKI development in this study on critically ill children with cerebral palsy.…”

“…Several risk factors were associated with severe AKI including transplantation, decreased renal perfusion, the use of nephrotoxic medications, radiocontrast exposure, poor nutrition and glycemic control, and major surgery as the most common findings (15 -17). However, the AWARE study data suggested that children are more likely to survive severe AKI than adults due to greater renal reserves in children (15). It is to be noted that AKI survivor children are at risk for chronic kidney disease, long-term follow-up is warranted.…”

Klotho Reduces Necroptosis by Targeting Oxidative Stress Involved in Renal Ischemic-Reperfusion Injury

“…Acute kidney injury (AKI) is a common and serious disorder associated with considerably high morbidity and mortality [1, 2]. It affects about 1 in 5 hospitalized patients worldwide and has mortality rates of 23.9% in adults and 13.8% in children [3].…”

Pediatric acute kidney injury: prevalence, impact and management challenges

“…Diagnosis of severe AKI conferred an increased risk of mortality by an adjusted odds ratio of 1.77 (95% CI, 1.17-2.68), with a mortality rate of 11% versus 2.5% (P<0.001) in patients without severe AKI. 12 The benefit of including multiple criteria (both serum creatinine and urine output) by which to increase sensitivity was also confirmed, as 67.2% of the patients found to have AKI by oliguria would have been missed if using serum creatinine alone. Strikingly, a significant increase in mortality was also observed (7.8% versus 2.9%, P=0.02) when severe AKI threshold (KDIGO Stage 2 or 3) was achieved due to oliguria compared to creatinine.…”

“…Strikingly, a significant increase in mortality was also observed (7.8% versus 2.9%, P=0.02) when severe AKI threshold (KDIGO Stage 2 or 3) was achieved due to oliguria compared to creatinine. 12 …”