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Healthcare Utilization after Acute Kidney Injury in the Pediatric Intensive Care Unit
Erin Hessey1, Geneviève Morissette, Jacques Lacroix
1Due to the number of contributing authors, the affiliations are provided in the Supplemental Material .
Insights
Pediatric acute kidney injury (AKI) is linked to increased hospitalizations and doctor visits after discharge. This study highlights the long-term health service burden associated with AKI in children.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Health Services Research
Background:
- Long-term health consequences of acute kidney injury (AKI) in pediatric intensive care units (PICU) are not well understood.
- Evaluating the post-hospitalization health service utilization is crucial for understanding the full impact of pediatric AKI.
Purpose of the Study:
- To determine if pediatric AKI is associated with increased health service use after hospital discharge.
- To quantify the long-term burden of AKI on hospitalizations, emergency room visits, and physician visits.
Main Methods:
- Retrospective cohort study of children (≤18 years) admitted to two tertiary care centers.
- AKI defined by serum creatinine alone or serum creatinine/urine output criteria.
- Health service use (hospitalizations, ER visits, physician visits) assessed over 30 days, 1 year, and 5 years using administrative data.
- Univariable and multivariable Poisson regression analyses were employed.
Main Results:
- 19-22% of included children developed AKI based on different definitions.
- Pediatric AKI was independently associated with significantly higher hospitalization risks at 1 and 5 years post-discharge.
- AKI was also associated with a higher risk of physician visits at 5 years.
- No significant association was found between AKI and emergency room visits after adjustment.
Conclusions:
- Pediatric AKI is an independent risk factor for increased hospitalizations and physician visits following hospital discharge.
- The findings underscore the significant long-term health service burden associated with AKI in children.
Background And Objectives:
Little is known about the long-term burden of AKI in the pediatric intensive care unit. We aim to evaluate if pediatric AKI is associated with higher health service use post-hospital discharge.
Design, Setting, Participants, & Measurements:
This is a retrospective cohort study of children (≤18 years old) admitted to two tertiary centers in Montreal, Canada. Only the first admission per patient was included. AKI was defined in two ways: serum creatinine alone or serum creatinine and/or urine output. The outcomes were 30-day, 1-year, and 5-year hospitalizations, emergency room visits, and physician visits per person-time using provincial administrative data. Univariable and multivariable Poisson regression were used to evaluate AKI associations with outcomes.
Results:
A total of 2041 children were included (56% male, mean admission age 6.5±5.8 years); 299 of 1575 (19%) developed AKI defined using serum creatinine alone, and when urine output was included in the AKI definition 355 of 1622 (22%) children developed AKI. AKI defined using serum creatinine alone and AKI defined using serum creatinine and urine output were both associated with higher 1- and 5-year hospitalization risk (AKI by serum creatinine alone adjusted relative risk, 1.42; 95% confidence interval, 1.12 to 1.82; and 1.80; 1.54 to 2.11, respectively [similar when urine output was included]) and higher 5-year physician visits (adjusted relative risk, 1.26; 95% confidence interval, 1.14 to 1.39). AKI was not associated with emergency room use after adjustments.
Conclusions:
AKI is independently associated with higher hospitalizations and physician visits postdischarge.
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