Quality improvement goals for pediatric acute kidney injury: pediatric applications of the 22nd Acute Disease Quality Initiative (ADQI) conference

Selewski, David T.; Askenazi, David; Kashani, Kianoush; Basu, Rajit K.; Gist, Katja M.; Harer, Matthew W.; Sutherland, Scott M.; Zappitelli, Michael; Ronco, Claudio; Goldstein, Stuart L.

doi:10.1007/s00467-020-04828-5

Cited by 26 publications

(28 citation statements)

References 69 publications

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“…Recovery from AKI has also been an important variable to monitor in this population and has been associated with long-term CKD development in children (46). Unfortunately, in retrospective studies, this can be difficult to assess as many patients with AKI do not have repeat creatinine measurements (47).…”

Section: Discussionmentioning

confidence: 99%

“…The 22nd Acute Disease Quality Initiative (ADQI) conference recently published quality improvement recommendations for pediatric AKI (46). This consensus statement recommends kidney health assessment every 1-2 years, which includes an AKI history, blood pressure measurement, serum creatinine measurement, and drug list review, in high-risk populations which include patients admitted to the PICU.…”

Section: Discussionmentioning

confidence: 99%

“…This consensus statement recommends kidney health assessment every 1-2 years, which includes an AKI history, blood pressure measurement, serum creatinine measurement, and drug list review, in high-risk populations which include patients admitted to the PICU. They also recommended kidney health assessment following an unplanned acute exposure such as PICU admission (46). These recommendations need evaluation for implementation in different health settings but are a welcome expert consensus statement that is likely to mitigate adverse outcomes in this high-risk population.…”

Section: Discussionmentioning

confidence: 99%

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Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years

et al. 2021

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Acute kidney injury (AKI) in the pediatric intensive care unit (PICU) is an important risk factor for increased morbidity and mortality during hospitalization. Over the past decade, accumulated data on children and young people indicates that acute episodes of kidney dysfunction can have lasting consequences on multiple organ systems and health outcomes. To date, there are no guidelines for follow-up of surviving children that may be at risk of long-term sequelae following AKI in the PICU. This narrative review aims to describe literature from the last 5 years on the risk of medium and long-term kidney and non-kidney outcomes after AKI in the PICU. More specifically, we will focus on outcomes in children and young people following AKI in the general PICU population and children undergoing cardiac surgery. These outcomes include mortality, hypertension, proteinuria, chronic kidney disease, and healthcare utilization. We also aim to highlight current gaps in knowledge in medium and long-term outcomes in this pediatric population. We suggest a framework for future research to develop evidence-based guidelines for follow-up of children surviving an episode of critical illness and AKI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years

et al. 2021

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“…The spectrum of AKI biomarkers in the pediatric population has been reviewed extensively elsewhere [ 11 , 12 , 13 , 14 ]. However, their implementation is restricted to small groups of patients and the results, rather of scientific than diagnostic value, could not modify the strategy of improvement for pediatric AKI [ 15 ]. Thus, despite the robustness of markers tested in the AKI conditions, only a few proved their usefulness in the prediction of AKI or prediction of recovery and found their place in everyday practice.…”

Section: Markers Of Injurymentioning

confidence: 99%

Current Concepts of Pediatric Acute Kidney Injury—Are We Ready to Translate Them into Everyday Practice?

Musiał

2021

JCM

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Pediatric acute kidney injury (AKI) is a major cause of morbidity and mortality in children undergoing interventional procedures. The review summarizes current classifications of AKI and acute kidney disease (AKD), as well as systematizes the knowledge on pathophysiology of kidney injury, with a special focus on renal functional reserve and tubuloglomerular feedback. The aim of this review is also to show the state-of-the-art in methods assessing risk and prognosis by discussing the potential role of risk stratification strategies, taking into account both glomerular function and clinical settings conditioned by fluid overload, urine output, or drug nephrotoxicity. The last task is to suggest careful assessment of eGFR as a surrogate marker of renal functional reserve and implementation of point-of-care testing, available in the case of biomarkers like NGAL and [IGFBP-7] × [TIMP-2] product, into everyday practice in patients at risk of AKI due to planned invasive procedures or treatment.

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“…Moreover, KDIGO reports, one in three children experienced AKI during hospital admission, with 30% of incidence among critically ill children [13]. The Assessment of Worldwide AKI Renal angina and Epidemiology (AWARE) study indicates that 15% of patients had AKI on the rst days of admission to the pediatric intensive care unit (PICU), 26.9% had developed AKI within the rst seven days of admission and 11.6% had severe AKI [5,9,14,15].…”

Section: Introductionmentioning

confidence: 99%

Risk factors associated with acute kidney injury in a pediatric intensive care unit in Addis Ababa, Ethiopia. Case control study

Keneni

Murugan

Bizuwork

et al. 2022

Preprint

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Background: Acute kidney injury (AKI) is a serious problem in critically ill children. It is associated with poor treatment outcomes and a high rate of morbidity and mortality. Globally, one in three critically ill admitted children suffer from acute kidney injury. However, limited data are available in Africa, particularly in Ethiopia, highlighting the risk factors related to acute kidney injury. Therefore, this study aimed to identify the risk factors associated with acute kidney injury among critically ill children admitted to the pediatric intensive care unit at the Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods: A facility-based unmatched case-control study was carried out on 253 (85 cases and 168 controls) children admitted to the pediatric intensive care unit from January 2011 to December 2021. Participants were selected using a systematic random sampling technique for the control group and all cases consecutively. Data were collected using a structured checklist. Data were entered using Epi data version 4.6 and analyzed using SPSS version 25. Multivariate analysis was carried out using the adjusted odds ratio (AOR) with a 95% confidence interval (CI) to identify associated factors with acute kidney injury. Statistical significance was set at P < 0.05. Results: The median age of the participants was two years. About 55.6 % of cases and 53.1% of controls were females. The diagnosis of hypertension (AOR= 5.36; 95% CI: 2.06- 13.93)], shock (AOR=3.88, 95% CI: 1.85- 8.12), exposure to nephrotoxic drugs (AOR=4.09; 95% CI: 1. 45- 11.59), sepsis or infection AOR=3.36; 95% CI: 1.42-7.99), nephritic syndrome (AOR=2.97; 95% CI :1.19, 7.43), and mechanical ventilation AOR=2.25, 95% CI: 1.12, 4.51) were significantly associated with acute kidney injury. Conclusion: In this study, the diagnosis of sepsis or infection, hypertension, shock, nephrotoxic drugs, demand for mechanical ventilation support, and nephritic syndrome increased the risk of AKI among critically ill children. Multiple risk factors for AKI are associated with illness and its severity. All measures that ensure adequate renal perfusion must be taken in children with identified risk factors to avoid the development of AKI.

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Quality improvement goals for pediatric acute kidney injury: pediatric applications of the 22nd Acute Disease Quality Initiative (ADQI) conference

Cited by 26 publications

References 69 publications

Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years

Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years

Current Concepts of Pediatric Acute Kidney Injury—Are We Ready to Translate Them into Everyday Practice?

Risk factors associated with acute kidney injury in a pediatric intensive care unit in Addis Ababa, Ethiopia. Case control study

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