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Published on: February 2, 2021
Outcome of pediatric acute kidney injury: a multicenter prospective cohort study
Jameela A Kari1, Khalid A Alhasan2, Mohamed A Shalaby3
1Pediatric Nephrology Center of Excellence, Department of Pediatrics, King Abdulaziz University, PO Box 80215, Jeddah, 21589, Kingdom of Saudi Arabia. jkari@kau.edu.sa.
Insights
Acute kidney injury (AKI) affects over one-third of critically ill children in pediatric intensive care units (PICUs). This condition significantly increases mortality risk and prolongs hospital stays for affected children.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Epidemiology
Background:
- Acute kidney injury (AKI) is a prevalent and growing concern in critically ill children.
- AKI is associated with significant morbidity and mortality in pediatric intensive care unit (PICU) admissions.
Purpose of the Study:
- To determine the incidence and outcomes of AKI in critically ill children.
- To investigate the association between AKI and mortality, hypertension, and length of stay in the PICU.
Main Methods:
- Prospective cohort study conducted over two years in three tertiary care hospitals in Saudi Arabia.
- Utilized the Kidney Disease Improving Global Outcomes (KDIGO) criteria for AKI diagnosis.
- Included 1367 pediatric PICU admissions.
Main Results:
- AKI was diagnosed in 37.4% of pediatric PICU admissions.
- Patients with AKI had a six-fold increased risk of in-hospital mortality (adjusted OR: 6.5).
- AKI was linked to a higher risk of hypertension and significantly longer PICU and hospital stays.
Conclusions:
- AKI complicates approximately one-third of pediatric intensive care unit admissions.
- AKI is independently associated with increased hospital mortality and extended lengths of stay in PICU and hospital.
Background:
Acute kidney injury (AKI) is a common problem encountered in critically ill children with an increasing incidence and evolving epidemiology. AKI carries a serious morbidity and mortality in patients requiring admission to a pediatric intensive care unit (PICU).
Methods:
We undertook a prospective cohort study of PICU admissions at three tertiary care hospitals in the Kingdom of Saudi Arabia over 2 years. The Kidney Disease Improving Global Outcomes (KDIGO) definition was used to diagnose AKI.
Results:
A total of 1367 pediatrics PICU admissions were included in the study. AKI affected 511 children (37.4%), with 243 children (17.8%) classified as stage I (mild), 168 patients (12.3%) stage II (moderate), and 100 children (7.3%) were classified as stage III (severe). After adjustment for age, sex, and underlying diagnosis, in-hospital mortality was six times more likely among patients with AKI as compared to patients with normal renal function (adjusted OR: 6.5, 95% CI: 4.2-10). AKI was also a risk factor for hypertension (adjusted OR: 4.1, 95% CI: 2.8-5.9) and prolonged stay in the PICU and hospital, as it increased the average number of admission days by 10 (95% CI: 8.6-11) days in the PICU and 12 (95% CI: 10-14) days in the hospital.
Conclusions:
One-third of PICU admissions were complicated with AKI. AKI was associated with increased hospital mortality and the length of stay in both PICU and hospital.
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