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Published on: August 9, 2013
Acute Kidney Injury among Hospitalized Children in China
Xin Xu1, Sheng Nie1, Aihua Zhang2
1National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Insights
Pediatric acute kidney injury (AKI) is common in China, affecting 20% of hospitalized children and often goes undiagnosed. Risk factors and outcomes vary by age and acquisition type, highlighting a critical public health issue.
Area of Science:
- Pediatric Nephrology
- Epidemiology
- Critical Care Medicine
Background:
- High-quality epidemiologic data on acute kidney injury (AKI) in children are scarce, especially in developing nations.
- Understanding AKI prevalence and characteristics in pediatric populations is crucial for improving healthcare.
- China's large pediatric population necessitates specific epidemiological insights into AKI.
Purpose of the Study:
- To assess the epidemiology of acute kidney injury (AKI) in hospitalized children in China.
- To identify clinical correlates and risk factors associated with pediatric AKI.
- To evaluate the in-hospital outcomes of pediatric AKI, including mortality and resource utilization.
Main Methods:
- Multicenter study involving 101,836 pediatric inpatients across 25 hospitals in China (2013-2015).
- Utilized electronic hospitalization data and laboratory results to identify AKI based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria.
- Employed Cox proportional hazard models to analyze risk factors and adjusted for covariates like age, sex, and comorbidities.
Main Results:
- A significant prevalence of AKI was found, with 19,908 (20%) of pediatric inpatients diagnosed with AKI.
- Community-acquired AKI (7%) and hospital-acquired AKI (13%) had distinct risk factors (e.g., diarrhea/sepsis vs. congenital heart disease/surgery).
- AKI was associated with a substantially higher in-hospital mortality (4% vs. 0.5%), longer hospital stays, and increased costs, with underdiagnosis noted in 96% of cases.
Conclusions:
- Pediatric acute kidney injury (AKI) is a common and significantly underdiagnosed condition among hospitalized children in China.
- The incidence and risk factors for AKI differ between community- and hospital-acquired cases and vary with age.
- AKI in children leads to poorer in-hospital outcomes, including increased mortality and resource utilization.
Background And Objectives:
High-quality epidemiologic data on AKI in children are particularly lacking in developing countries. This study aimed to assess the epidemiology and clinical correlates of AKI among hospitalized children in China.
Design, Setting, Participants, & Measurements:
We performed a multicenter study, in a cohort of hospitalized children aged 1 month to 18 years, from 25 general and children's hospitals in China during 2013-2015. We obtained patient-level data from the electronic hospitalization information system and laboratory databases of all children who had at least two serum creatinine tests within any 7-day window during their first 30 days of hospitalization. We identified AKI events according to the creatinine criteria of Kidney Disease Improving Global Outcomes. The in-hospital outcomes of AKI, including mortality, kidney recovery, and length of stay, were assessed. We estimated the corresponding hazard ratios using a Cox proportional hazard model, with adjustment for age, sex, comorbidities, and clinical procedures.
Results:
A total of 19,908 (20%) patients with AKI were identified among 101,836 pediatric inpatients, of which 7220 (7%) were community acquired and 12,688 (13%) were hospital acquired. Up to 96% of these AKI events were not diagnosed on the discharge records. The cumulative incidence of AKI in infants (28%) was twice that in adolescents (12%). The profiles of risk factors differed between community-acquired and hospital-acquired AKI and varied with age. Diarrhea and sepsis were the top risk factors for community-acquired AKI, each contributing 6% of the risk. Congenital heart disease/cardiac surgery was the major risk factor for hospital-acquired AKI, contributing to 19% of cases. Exposure to nephrotoxic drugs, mostly nonsteroidal anti-inflammatory drugs and proton pump inhibitors, was common in hospitalized children and was associated with a higher risk of AKI. Death occurred in 842 out of 19,908 patients (4%) with AKI versus 450 out of 81,478 children (0.5%) without AKI. The risk of in-hospital death was higher among children with severe AKI, shock, and respiratory failure. Pediatric AKI was associated with longer hospital stay and higher daily cost, even after adjustment for covariates.
Conclusions:
Pediatric AKI is common and is substantially underdiagnosed in China.
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