Impact of acute kidney injury and nephrotoxic exposure on hospital length of stay



Acute kidney injury (AKI) is a common occurrence among hospitalized children and leads to increased mortality and prolonged length of stay (LOS) in critically ill patients. Few studies have examined the impact of AKI on LOS for common pediatric conditions. We hypothesized that a diagnosis of AKI would be associated with a longer hospital LOS and increased exposure to nephrotoxic medications for all patients.

Patients and methods

We performed a multicenter retrospective cross-sectional analysis of 34 children’s hospitals in the Pediatric Health Information System (PHIS) database from 1/2009 through 12/2013. Patients were grouped based on primary discharge diagnosis, number of days spent in an intensive care unit, and assignment of a secondary diagnostic code for AKI. Median LOS was compared among different patient groupings. Exposure to commonly used nephrotoxic medications was collected for each admission.


A total of 588,884 admissions from 423,337 patients were included in the analysis. The median LOS among non-critically ill patients with and without AKI was 5 days [95% CI 3–10] versus 2 days [95% CI 1–4], respectively. Among critically ill patients, median LOS for those with and without AKI was 12 days [95% CI 7–20] versus 4 days [95% CI 2–7], respectively. Patients who developed AKI were more likely to have significant nephrotoxic exposure.


Development of AKI was associated with longer hospital length of stay and increased nephrotoxic medication exposure for all diagnostic categories. Non-critically ill children with AKI were hospitalized the same length or longer than critically ill children without AKI.

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The authors would like to thank Matt Barhight, MD and Emily Mack, BS, MS for their contributions sharing data on local AKI diagnosis at Children’s Hospital Colorado. The authors would also like to thank the Research Institute of the University of Colorado and Department of Pediatrics for their support of the Pediatric Kidney Injury and Disease Stewardship team that helped with this project.

Financial Disclosure

Katja Gist is a consultant for BioPorto® Diagnostics. The other authors have no financial relationships relevant to this article to disclose.

Author information

Dr. Searns, Dr. Gist, and Dr. Soranno conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the final manuscript. Meghan Birkholz designed the data collection instruments including our Pediatric Health Information System queries, collected and organized the dataset, and reviewed and revised the manuscript. Dr. Todd helped conceptualize the design for the study, revised our PHIS database query approach, and reviewed and revised the manuscript. Dr. Brinton and Kaci Pickett provided statistical analysis and design for the study and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. Dr. Searns and Dr. Gist serve as co-first authors on this manuscript.

Correspondence to Danielle E. Soranno.

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Searns, J.B., Gist, K.M., Brinton, J.T. et al. Impact of acute kidney injury and nephrotoxic exposure on hospital length of stay. Pediatr Nephrol (2020).

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  • Pediatric
  • Acute kidney injury
  • Hospital length of stay
  • Nephrotoxic