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Acute kidney injury in hospitalized children with proteinuria: A multicenter retrospective analysis
Katelyn H Baggett1, Tomas Manghi2, Vonn Walter3
1Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States of America.
Insights
Proteinuria in hospitalized children on the first day of care is linked to higher risks of acute kidney injury (AKI), need for renal replacement therapy, shock, antibiotic use, and 30-day mortality.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Clinical Outcomes Research
Background:
- Acute kidney injury (AKI) is a significant concern in hospitalized children.
- Previous adult studies suggest proteinuria indicates AKI and adverse outcomes.
- The predictive value of early-onset proteinuria in pediatric AKI requires further investigation.
Purpose of the Study:
- To determine if proteinuria on hospital day one is associated with AKI in pediatric patients.
- To assess the association between early proteinuria and critical care outcomes, including renal replacement therapy, shock, antibiotic use, and 30-day mortality.
- To hypothesize a link between early proteinuria and adverse clinical outcomes in hospitalized children.
Main Methods:
- Retrospective cohort study utilizing TriNetX electronic health records.
- Inclusion criteria: pediatric patients (2-18 years) with urinalysis, 3 days of hospital/critical care billing, and creatinine values; exclusion of pre-existing renal conditions.
- AKI definition based on Kidney Disease: Improving Global Outcomes (KDIGO) modified criteria; assessment of associated clinical outcomes.
Main Results:
- The study included 971 pediatric subjects, with 44.7% exhibiting proteinuria.
- Proteinuria was associated with increased odds of higher AKI severity (OR 2.41), need for renal replacement therapy (OR 4.58), shock/antibiotic use (OR 1.34), and 30-day mortality (OR 10.0).
- Significant associations were found for AKI severity, renal replacement therapy, shock/antibiotic use, and mortality.
Conclusions:
- Early proteinuria in hospitalized children is a potential indicator of increased risk for severe AKI.
- Proteinuria may predict the need for renal replacement therapy, shock, antibiotic use, and 30-day mortality.
- No significant association was found between early proteinuria and critical care services, mechanical intubation, or inotrope/vasopressor use.
Background And Objective:
Acute kidney injury (AKI) is a common complication in hospitalized pediatric patients. Previous studies focused on adults found that proteinuria detected during an admission urinalysis is fit to serve as an indicator for AKI and associated clinical outcomes. The objective of this study is to evaluate if proteinuria on the first day of hospital services in hospitalized children is associated with AKI, need for renal replacement therapy, shock and/or antibiotic use, critical care services, and all-cause mortality at 30 days, hypothesizing that it is associated with these outcomes.
Methods:
This is a retrospective cohort study using TriNetX electronic health record data of patients 2 to 18 years of age who underwent urinalysis laboratory testing on hospital admission, had three subsequent days of hospital or critical care services billing codes and creatinine laboratory values, and no pre-existing renal-related complex chronic condition. This study evaluated for the frequency, odds, and severity of AKI as defined by Kidney Disease: Improving Global Outcomes modified criteria and assessed for associated clinical outcomes.
Results:
This study included 971 pediatric subjects [435 (44.7%) with proteinuria]. Proteinuria on the first day of hospital services was associated with an increased odds for higher severity AKI on any day of hospitalization (odds ratio [OR] 2.41, CI 1.8-3.23, p<0.001), need for renal replacement therapy (OR 4.58, CI 1.69-12.4, p = 0.001), shock and/or antibiotic use (OR 1.34, CI 1.03-1.75, p = 0.033), and all-cause mortality at 30 days post-admission (OR 10.0, CI 1.25-80.5, p = 0.013).
Conclusion:
Children with proteinuria on the first day of hospital care services may have an increased odds of higher severity AKI, need for renal replacement therapy, shock and/or antibiotic use, and all-cause mortality at 30 days post-admission, with no significant association found for critical care services, mechanical intubation, or inotrope or vasopressor use.
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