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Acute kidney injury: epidemiology and course in critically ill children

Chian Wern Tai1,2,3, Kristen Gibbons1, Andreas Schibler1,2

  • 1Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, QLD, 4101, Australia.

Journal of Nephrology
|June 2, 2021
PubMed

Insights

Nearly 10% of critically ill children develop acute kidney injury (AKI). While most recover within 7 days, persistent kidney dysfunction requires further study to understand long-term effects.

Area of Science:

  • Pediatric Critical Care Medicine
  • Nephrology
  • Clinical Epidemiology

Background:

  • Acute kidney injury (AKI) is a significant contributor to poor outcomes in critically ill children.
  • Understanding AKI prevalence and classification is crucial for effective management.

Purpose of the Study:

  • To determine the incidence and course of AKI in a pediatric intensive care unit (ICU).
  • To compare the performance of KDIGO, pRIFLE, and pROCK criteria for AKI classification in children.

Main Methods:

  • A retrospective observational study of 7505 children admitted to a multi-disciplinary Pediatric ICU (January 2015 - December 2018).
  • AKI was classified using Kidney Disease Improving Global Outcomes (KDIGO) criteria as the reference standard.
  • Incidence and classification were compared with pediatric risk, injury, failure, loss of kidney function (pRIFLE) and pediatric reference change value optimised for AKI (pROCK) criteria.

Main Results:

  • 9.2% of patients developed AKI based on KDIGO criteria, with most (59.8%) having Stage 1 AKI.
  • Recovery occurred in 70.4% within 7 days; however, 30% experienced persistent AKI.
  • KDIGO criteria demonstrated higher sensitivity for AKI classification compared to pRIFLE and pROCK.
  • Patients meeting all three criteria exhibited a high mortality rate of 35.0%.

Conclusions:

  • Approximately 1 in 10 critically ill children meet KDIGO criteria for AKI.
  • A significant proportion of pediatric ICU patients experience AKI lasting longer than 7 days.
  • Long-term follow-up is essential to assess the morbidity associated with persistent kidney dysfunction post-discharge.
Abstract

Keywords:
Acute kidney injuryCourseCritically ill childrenDefinitionsEpidemiology

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