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Community-Based Epidemiology of Hospitalized Acute Kidney Injury
Rishi V Parikh1, Thida C Tan1, Anne S Salyer2
1Division of Research, Kaiser Permanente Northern California, Oakland, California.
Pediatrics
|August 14, 2020
Summary
Pediatric acute kidney injury (AKI) affects about 1 in 1000 children annually, often occurring outside the ICU. Many children with AKI do not receive timely follow-up kidney function testing after hospitalization.
Area of Science:
- Pediatric Nephrology
- Epidemiology
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) in children can have lasting health effects.
- Population-level data on pediatric AKI, especially outside intensive care units (ICUs), is limited.
Purpose of the Study:
- To determine the incidence of hospitalized AKI in a large pediatric population.
- To assess the proportion of AKI cases occurring outside ICUs.
- To evaluate follow-up kidney function testing rates after pediatric AKI hospitalization.
Main Methods:
- Analysis of a large, diverse pediatric cohort (2008-2016) within an integrated healthcare system.
- Calculation of age- and sex-adjusted AKI incidence using consensus serum creatinine criteria.
- Investigation of AKI detection in non-ICU settings and outpatient follow-up testing rates.
Main Results:
- The overall incidence of hospitalized pediatric AKI was approximately 0.70 per 1000 person-years.
- The incidence of AKI among hospitalized children increased from 6.0% to 8.8% between 2008 and 2016.
- Two-thirds of AKI episodes occurred outside the ICU, and over half of unresolved AKI cases lacked follow-up testing within 30 days.
Conclusions:
- Community-based pediatric AKI incidence is about 1 per 1000 child-years.
- A significant proportion of pediatric AKI occurs outside the ICU and is not followed by adequate kidney function monitoring.
- Improved recognition and targeted post-discharge monitoring are crucial for managing pediatric AKI.
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