The incidence of pediatric acute kidney injury is increased when identified by a change in a creatinine-based electronic alert

Abstract

A prospective national cohort study was undertaken to collect data on all cases of pediatric (under 18 yrs of age) acute kidney injury (AKI) identified by a biochemistry-based electronic alert using the Welsh National electronic AKI reporting system. Herein we describe the utility and limitation of using this modification of the KDIGO creatinine-based system data set to characterize pediatric AKI. Of 1,343 incident episodes over a 30-month period, 34.5% occurred in neonates of which 83.8% were AKI stage 1. Neonatal 30-day mortality was 4.1%, with 73.3% of this being accounted for by patients treated in an Intensive Care Unit. In the non-neonatal group, 76.1% were AKI stage 1. Hospital-acquired AKI accounted for 40.1% of episodes while community-acquired AKI represented 29.4% of cases within which 33.9% were admitted to hospital and 30.5% of cases were unclassified. Non-neonatal 30-day mortality was 1.2%, with half of this accounted for by patients treated in the Intensive Care Unit. Nonrecovery of renal function at 30 days occurred in 28% and was significantly higher in patients not admitted to hospital (45% vs. 20%). The reported incidence of AKI in children was far greater than previously reported in studies reliant on clinical identification of adult AKI or hospital coding data. Mortality was highest in neonates and driven by those in the Intensive Care Unit. Nonrecovery of renal function and persistent renal impairment was more common in non-neonates and was especially high in patients with community-acquired AKI who were not hospitalized.

Theophylline and aminophylline for prevention of acute kidney injury in neonates and children: a systematic review

“…AKI may result from impaired renal perfusion, exposure to nephrotoxic drugs, sepsis or ischaemia during surgery, such as cardiopulmonary bypass 2. In a recent prospective national cohort study using electronic alert system, the incidence of hospital and community acquired AKI in children was found to be 40.1% and 29.4%, respectively 3. The reported incidence of neonatal AKI ranges from 8.4% to 34.5%3–5 and is associated with increased mortality, longer duration of hospital stay and an increased cost 6 7.…”

Adding a new dimension to the weekend effect: an analysis of a national data set of electronic AKI alerts

“…Based on a presumption that early identification may facilitate appropirate of care and improve patient outcomes, an automated real time e-alert system for AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) change in creatinine diagnostic criteria has been established and implemented nationally across all areas of the National Health Service in Wales, and the other home countries of the United Kingdom. Using the electronic AKI alert, we have developed a centralised data collection system to provide a comprehensive characterisation of the incidence of AKI identified by an electronic alert, and its outcome in Wales [19][20][21] .…”

Seasonal pattern of incidence and outcome of Acute Kidney Injury: A national study of Welsh AKI electronic alerts

“…13 In addition to prompting clinicians to intervene at an early stage, this also provides a valuable source of data regarding the epidemiology of AKI. We have previously used this dataset to report the incidence and outcome of AKI in adult 14 and paediatric Dafydd Phillips and Oliver Young made an equal contribution to this manuscript patients 15 in Wales (UK). More recently we have demonstrated the significance of the electronic AKI alert in primary care.…”