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Acute kidney injury: epidemiology and course in critically ill children

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Journal of Nephrology Aims and scope Submit manuscript

Abstract

Background

Acute kidney injury (AKI) is a major cause of morbidity and mortality in critically ill children. The aim of this paper was to describe the prevalence and course of AKI in critically ill children and to compare different AKI classification criteria.

Methods

We conducted a retrospective observational study in our multi-disciplinary Pediatric Intensive Care Unit (ICU) from January 2015 to December 2018. All patients from birth to 16 years of age who were admitted to the pediatric ICU were included. The Kidney Disease Improving Global Outcomes (KDIGO) definition was considered as the reference standard. We compared the incidence data assessed by KDIGO, pediatric risk, injury, failure, loss of kidney function and end- stage renal disease (pRIFLE) and pediatric reference change value optimised for AKI (pROCK).

Results

Out of 7505 patients, 9.2% developed AKI by KDIGO criteria. The majority (59.8%) presented with stage 1 AKI. Recovery from AKI was observed in 70.4% of patients within 7 days from diagnosis. Both pRIFLE and pROCK were less sensitive compared to KDIGO criteria for the classification of AKI. Patients who met all three—KDIGO, pRIFLE and pROCK criteria had a high mortality rate (35.0%).

Conclusion

Close to one in ten patients admitted to the pediatric ICU met AKI criteria according to KDIGO. In about 30% of patients, AKI persisted beyond 7 days. Follow-up of patients with persistent kidney function reduction at hospital discharge is needed to reveal the long-term morbidity due to AKI in the pediatric ICU.

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Availability of data and materials

All data generated or analyzed during this study are included in this published article and its supplementary material.

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Acknowledgements

We thank the pediatric ICU Metavision data management team for their help with data extraction for this study. Special thanks to Endrias Ergetu (Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Queensland, Australia) for his help with the digital artwork.

Funding

LJS is supported by a Practitioner Fellowship of the National Health and Medical Research Council of Australia and New Zealand, and by the Children`s Hospital Foundation, Brisbane, Australia.

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Authors and Affiliations

  1. Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, QLD, 4101, Australia

    Chian Wern Tai, Kristen Gibbons, Andreas Schibler, Luregn J. Schlapbach & Sainath Raman

  2. Paediatric Intensive Care Unit, Queensland Children’s Hospital, South Brisbane, Australia

    Chian Wern Tai, Andreas Schibler, Luregn J. Schlapbach & Sainath Raman

  3. Department of Paediatrics, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia

    Chian Wern Tai

  4. Neonatal and Pediatric Intensive Care Unit, Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland

    Luregn J. Schlapbach

Authors
  1. Chian Wern Tai
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  2. Kristen Gibbons
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  3. Andreas Schibler
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  4. Luregn J. Schlapbach
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  5. Sainath Raman
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Contributions

CWT and SR verified the data extraction codes, analyzed the data and wrote the first draft of the article. KG and SR checked accuracy of data analysis. CWT, AS, LJS and SR contributed to design of the study, interpretation of findings and manuscript writing. All authors read and approved the final manuscript except AS who was unfortunately very ill.

Corresponding author

Correspondence to Sainath Raman.

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Conflict of interest

The authors declare that they have no competing interests.

Ethics approval

Ethics approval was obtained from Children’s Health Queensland HREC (HREC/17/QRCH/287). A waiver of consent for access to patient records was granted.

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Tai, C.W., Gibbons, K., Schibler, A. et al. Acute kidney injury: epidemiology and course in critically ill children. J Nephrol 35, 559–565 (2022). https://doi.org/10.1007/s40620-021-01071-5

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  • DOI: https://doi.org/10.1007/s40620-021-01071-5

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