Acute Kidney Injury in Critically Ill Children: Prevalence, Progression, Recovery Mortality, and Impact of Severity

Introduction: Acute kidney injury (AKI) among the pediatric population is considered a risk factor for mortality and morbidities during pediatric intensive care unit (PICU) admission. The association between AKI and increased mortality risk and length of stay (LOS) is still inconclusive. This retrospective cohort study aimed to evaluate the impact of AKI severity upon critical management and clinical parameters with an evaluation of severity progression among AKI patients admitted to the PICU at a tertiary care hospital. Methods: AKI, defined with the Kidney Disease Improving Global Outcomes (KDIGO) classification, was determined based on serum creatinine and urine output with respect to the patient's baseline value. The following outcomes were examined: mortality, mechanical ventilation use, use of non-invasive ventilation, recovery at discharge, and LOS in the hospital and PICU stratified by type of AKI upon admission. Medical records of the 165 included patients were reviewed for clinical data and study outcomes. Results: The median age of the patients was 7 years (IQR 1.5-10 years), and 58% were boys; 78 (47.2%) had stage 1 AKI, 49 (29.71%) had stage 2 AKI, and 38 (23%) had stage 3 AKI at admission. The mortality rate was 26%. The median LOS in the PICU was statistically significant between AKI stages, with a higher median LOS among patients with AKI stage 3 at admission. Using the maximum KDIGO stage, there was no association between AKI and mortality (adjusted OR 1.91, 95% CI 0.05), whereas for the mechanical ventilation outcome, the adjusted OR was 1.84 (95% CI 0.42-8.1). Conclusions: The severity of AKI is not associated solely with mortality and clinical outcomes as the numbers of comorbidities and organ failures contribute to mortality. However, improving awareness of AKI and understanding the disease progression course would reduce acute and long-term morbidity and mortality.