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Acute Kidney Injury in Children Hospitalized With Diarrheal Illness in the United States
Christina Bradshaw1, Jialin Han2, Glenn M Chertow2,3
1Division of Nephrology, Department of Medicine, cbradsha@stanford.edu.
Insights
Acute kidney injury (AKI) affects 0.8% of children hospitalized for diarrhea. AKI significantly increases mortality risk, hospital stay, and costs in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Hospital Medicine
- Epidemiology
Background:
- Diarrheal illness is a common reason for pediatric hospitalization in the US.
- Acute kidney injury (AKI) is a serious complication that can occur in hospitalized children.
- Understanding the incidence and impact of AKI in this population is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence, correlates, and consequences of AKI in children hospitalized with diarrheal illness.
- To identify risk factors associated with AKI development in this pediatric cohort.
- To quantify the impact of AKI on mortality, length of stay, and hospital costs.
Main Methods:
- Utilized data from the 2009 and 2012 Kids' Inpatient Database for children with a primary diagnosis of diarrheal illness (N=113,195).
- Employed International Classification of Diseases, Ninth Revision, Clinical Modification codes (584.5-584.9) to identify cases of AKI.
- Applied stepwise logistic regression and generalized linear models to analyze incidence, correlates, and consequences (mortality, LOS, costs).
Main Results:
- The incidence of AKI among children hospitalized with diarrhea was 0.8%.
- Factors associated with AKI included hospital characteristics, older age, solid organ transplant, hypertension, CKD, and rheumatologic/hematologic conditions.
- AKI was linked to an 8-fold increase in mortality odds, a 3.0-day increase in LOS, and an additional $9241 in hospital costs.
Conclusions:
- Demographic factors and comorbidities significantly influence AKI risk in children hospitalized for diarrhea.
- While AKI is relatively rare in this context, its occurrence is associated with substantially worse outcomes.
- Effective management strategies for AKI in pediatric diarrheal illness are essential to reduce mortality and healthcare expenditures.
Objectives:
To determine the incidence, correlates, and consequences of acute kidney injury (AKI) among children hospitalized with diarrheal illness in the United States.
Methods:
Using data from Kids' Inpatient Database in 2009 and 2012, we studied children hospitalized with a primary diagnosis of diarrheal illness (weighted N = 113 195). We used the International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis codes 584.5 to 584.9 to capture AKI. We calculated the incidence, correlates, and consequences (mortality, length of stay [LOS], and costs) of AKI associated with hospitalized diarrheal illness using stepwise logistic regression and generalized linear models.
Results:
The average incidence of AKI in children hospitalized with diarrheal illness was 0.8%. Hospital location and teaching status were associated with the odds of AKI, as were older age, solid organ transplant, hypertension, chronic kidney disease, and rheumatologic and hematologic conditions. The development of AKI in hospitalized diarrheal illness was associated with an eightfold increase in the odds of in-hospital mortality (odds ratio 8.0; 95% confidence interval [CI] 4.2-15.4). AKI was associated with prolonged LOS (mean increase 3.0 days; 95% CI 2.3-3.8) and higher hospital cost (mean increase $9241; 95% CI $4661-$13 820).
Conclusions:
Several demographic factors and comorbid conditions are associated with the risk of AKI in children hospitalized with diarrheal illness. Although rare, development of AKI in this common pediatric condition is associated with increased mortality, LOS, and hospital cost.
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