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Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population

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Abstract

Purpose

Acute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney Disease: Improving Global Outcomes (KDIGO) AKI working group has proposed a standardized definition of AKI. Utilizing routinely available clinical data, we evaluated the KDIGO AKI criteria and the relationship of AKI with relevant outcomes in a single center tertiary pediatric intensive care (PICU) and cardiac intensive care unit (CICU) population.

Methods

The University of Michigan Pediatric Critical Care Database was probed for all discharges from the pediatric intensive care and cardiac intensive care units between July 2011 and October 2013 (N = 4,645). The KDIGO serum creatinine (SCr)-based criteria staged AKI with the modification that a minimum SCr of greater than 0.5 mg/dL was required to be classified as AKI. Exclusion: end-stage renal disease, new renal transplant, missing PRISM III data, or no measured Cr during intensive care unit (ICU) admission (N = 1,636).

Results

AKI occurred in 737 (24.5 %, stage 1 = 193, stage 2 = 189, and stage 3 = 355) of 3,009 discharges (PICU N = 1,870, CICU N = 1,139) that included 2,415 patients. In multivariate analysis AKI was associated with increased ICU length of stay (LOS) in hours (stage I β = 42.2, p = 0.024, II β = 74.1, p = 0.003, III β = 215.8, p < 0.001). Multivariate analysis showed that AKI was associated with increased odds of ICU mortality (OR 3.4, 95 % CI 2.0–6.0) and increased length of mechanical ventilation among those requiring mechanical ventilation (β = 2.3 days, p < 0.001).

Conclusions

Using the KDIGO criteria to define AKI, we observed a high prevalence of AKI among critically ill children. Worsening stages of AKI were associated with increased ICU LOS, and AKI was independently associated with prolonged mechanical ventilation and increased mortality. The KDIGO criteria describe clinically relevant AKI in a broad pediatric critical care population.

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Acknowledgments

The authors wish to thank the Department of Pediatrics and Communicable Disease at the University of Michigan for supporting this project. The authors also wish to thank the Clinical Research Informatics Core within the Michigan Institute for Clinical and Health Research (supported by 2UL1TR000433), as well as the Honest Broker Office of the University of Michigan Medical School for their assistance with this work. This work was supported by a grant from the Renal Research Institute.

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA

    David T. Selewski, Jonathan P. Troost, Brett J. Ehrmann, Rebecca M. Lombel, Neal B. Blatt, Kera Luckritz, Sue Hieber, David B. Kershaw & Debbie S. Gipson

  2. Division of Critical Care, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA

    Timothy T. Cornell & Thomas P. Shanley

  3. Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Michael Heung

  4. Division of Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA

    Robert Gajarski

Authors
  1. David T. Selewski
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  2. Timothy T. Cornell
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  3. Michael Heung
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  4. Jonathan P. Troost
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  5. Brett J. Ehrmann
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  6. Rebecca M. Lombel
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  7. Neal B. Blatt
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  8. Kera Luckritz
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  9. Sue Hieber
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  10. Robert Gajarski
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  11. David B. Kershaw
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  12. Thomas P. Shanley
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  13. Debbie S. Gipson
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Corresponding author

Correspondence to David T. Selewski.

Additional information

Take-home message: Using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria to define AKI we observed a high prevalence of AKI among critically ill children. The KDIGO criteria describe clinically relevant AKI in a broad pediatric critical care population.

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Selewski, D.T., Cornell, T.T., Heung, M. et al. Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population. Intensive Care Med 40, 1481–1488 (2014). https://doi.org/10.1007/s00134-014-3391-8

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  • DOI: https://doi.org/10.1007/s00134-014-3391-8

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