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Association Between Acute Kidney Injury Duration and Outcomes in Critically Ill Children
Rashid Alobaidi1, Natalie Anton1, Shauna Burkholder2
1Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alberta and Stollery Children's Hospital, Edmonton, AB, Canada.
Insights
Acute kidney injury (AKI) in critically ill children is common. Even transient AKI is linked to worse outcomes, with persistent AKI significantly increasing mortality and morbidity.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Epidemiology
Background:
- Acute kidney injury (AKI) is a frequent complication in critically ill children.
- AKI in this population is associated with increased mortality, morbidity, and healthcare resource utilization.
- The impact of AKI duration on these outcomes requires further investigation.
Purpose of the Study:
- To examine the association between the duration of acute kidney injury (AKI) and clinical outcomes in critically ill children.
- To differentiate outcomes based on transient (≤48 hours) versus persistent (>48 hours) AKI.
Main Methods:
- Retrospective cohort study including 1,017 children admitted to Pediatric Intensive Care Units (PICUs) in Alberta, Canada, from January 1, 2015, to December 31, 2015.
- Children were categorized into no AKI, transient AKI, or persistent AKI groups.
- Outcomes analyzed included mortality, ventilation-free days, vasoactive support-free days, and hospital-free days.
Main Results:
- 30.3% of children developed AKI, with 77.9% experiencing transient AKI and 22.1% experiencing persistent AKI.
- Persistent AKI was associated with higher AKI severity, increased illness severity, and higher rates of shock and sepsis.
- Mortality rates were significantly higher for children with transient (5.4%) and persistent (17.6%) AKI compared to no AKI (1.8%).
- Both transient and persistent AKI were independently associated with reduced ventilation-free, vasoactive support-free, and hospital-free days.
Conclusions:
- Persistent and transient AKI in critically ill children have distinct clinical characteristics and outcome associations.
- Even short-duration AKI is significantly associated with adverse outcomes.
- The risk of poor outcomes increases substantially with longer AKI duration, irrespective of AKI severity.
Objectives:
Acute kidney injury occurs frequently in children during critical illness and is associated with increased morbidity, mortality, and health resource utilization. We aimed to examine the association between acute kidney injury duration and these outcomes.
Design:
Retrospective cohort study.
Settings:
PICUs in Alberta, Canada.
Patients:
All children admitted to PICUs in Alberta, Canada between January 1, 2015, and December 31, 2015.
Interventions:
None.
Measurements And Main Results:
In total, 1,017 children were included, and 308 (30.3%) developed acute kidney injury during PICU stay. Acute kidney injury was categorized based on duration to transient (48 hr or less) or persistent (more than 48 hr). Transient acute kidney injury occurred in 240 children (77.9%), whereas 68 children (22.1%) had persistent acute kidney injury. Persistent acute kidney injury had a higher proportion of stage 2 and stage 3 acute kidney injury compared with transient acute kidney injury and was more likely to start within 24 hours from PICU admission. Persistent acute kidney injury occurred more frequently in those with higher illness severity and in those admitted with shock, sepsis, or with a history of transplant. Mortality varied significantly according to acute kidney injury status: 1.8% of children with no acute kidney injury, 5.4% with transient acute kidney injury, and 17.6% with persistent acute kidney injury died during hospital stay (p < 0.001). On multivariable analysis adjusting for illness and acute kidney injury severity, transient and persistent acute kidney injury were both associated with fewer ventilation-free days at 28 days (-1.28 d; 95% CI, -2.29 to -0.26 and -4.85 d; 95% CI, -6.82 to -2.88), vasoactive support-free days (-1.07 d; 95% CI, -2.00 to -0.15 and -4.24 d; 95% CI, -6.03 to -2.45), and hospital-free days (-1.93 d; 95% CI, -3.36 to -0.49 and -5.25 d; 95% CI, -8.03 to -2.47), respectively.
Conclusions:
In critically ill children, persistent and transient acute kidney injury have different clinical characteristics and association with outcomes. Acute kidney injury, even when its duration is short, carries significant association with worse outcomes. This risk increases further if acute kidney injury persists longer independent of the degree of its severity.
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