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Pediatric acute kidney injury in North India: A prospective hospital-based study
1Division of Nephrology, Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.
Insights
Acute kidney injury (AKI) affects over 25% of hospitalized pediatric patients, with higher incidence in critically ill children. AKI significantly increases mortality risk, especially in severe stages.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Clinical Epidemiology
Background:
- Acute kidney injury (AKI) is a significant concern in hospitalized children.
- The AKI Network (AKIN) criteria provide a standardized method for diagnosing AKI.
- Understanding AKI incidence and risk factors in pediatric populations is crucial for improving outcomes.
Purpose of the Study:
- To determine the incidence and clinical profile of AKI in hospitalized pediatric patients.
- To identify factors associated with AKI development and mortality in this cohort.
- To evaluate the impact of AKI severity on patient outcomes.
Main Methods:
- A prospective observational study was conducted in a tertiary care hospital in North India.
- 600 pediatric patients (3 months to 12 years) were enrolled and assessed for AKI using AKIN criteria.
- Statistical analysis was performed to identify predictors of AKI and mortality.
Main Results:
- The overall incidence of AKI was 25.2%, significantly higher in critically ill (53.2%) versus non-critically ill (16.6%) children.
- Nephrotoxic drugs, hypovolemia, sepsis, and mechanical ventilation were independent predictors of AKI.
- AKI was associated with increased hospital stay, higher PIM-2 scores, and a substantially higher mortality rate (28.5% vs. 3.6%).
- Stage 3 AKI had a mortality rate of 60.9%, with acidosis, mechanical ventilation, shock, and sepsis as key mortality predictors.
Conclusions:
- AKI is highly prevalent in hospitalized pediatric patients, including non-critically ill children.
- AKI is an independent risk factor for mortality, with risk escalating with AKI severity.
- Early recognition and management of AKI and its associated risk factors are vital in pediatric care.
Abstract:
The conducted study aimed to determine the incidence and clinical profile of acute kidney injury (AKI) in hospitalized patients using the AKI Network (AKIN) criteria. This prospective observational study was conducted at the Pediatric ward and pediatric Intensive Care Unit of a tertiary level teaching hospital in North India. The participants were 763 consecutive patients aged three months to 12 years from January 2014 to October 2015 and were assessed for eligibility. Of these, 163 patients were excluded from the study. Main outcome measure was incidence of AKI based on the AKIN criteria. Factors associated with AKI were analyzed. A total of 600 patients (141 critically ill and 459 noncritically ill) were enrolled. The incidence of AKI was 25.2% (n = 151); it was significantly higher among critically ill (53.2%) than non-critically ill patients (16.6%), P <0.001. Most patients with AKI were in Stage 1 (n = 99; 65.6%). Ten patients (6.6%) required dialysis (peritoneal dialysis n = 8; hemodialysis n = 2). Patient with AKI had significantly higher median (interquartile range) PIM-2 score, 22.6 (5-61.7), longer hospital stay (10 vs. 7 days), and mortality rate (28.5% vs. 3.6%); P <0.001. Nephrotoxic drugs [hazard ratio (HR): 5.5, 95% confidence interval (CI): 2.6-11.4; P = 0.001]; hypovolemia (HR: 1.7, 95% CI: 1-2.7; P = 0.035); sepsis (HR 2.3, 95% CI: 1.1-5); and mechanical ventilation (HR: 3.3, 95% CI: 1.6-6.8) were independent predictors for AKI. AKI was an independent risk factor for mortality and risk increased with increasing stage of AKI. Mortality was significantly higher in Stage 3 AKI (n = 14; 60.9%); P <0.001. Independent predictors for mortality in AKI were acidosis (HR: 3.6; 95% CI 1.5-8.6), mechanical ventilation (HR: 34; 95% CI 9.3-123), shock (HR: 19.7; 95% CI 2-194), and sepsis (HR: 3; 95% CI 1-8). The incidence of AKI is high among pediatric patients admitted to this center, including among noncritically ill children. AKI is associated with significantly increased morbidity and mortality.
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