High Rates of AKI in Pediatric ICUs

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Acute kidney injury (AKI), often severe, develops in more than one-fourth of children admitted to pediatric intensive care units, reports a study in The New England Journal of Medicine.

The prospective study included data on patients (aged 3 months to 25 years) admitted to 32 pediatric ICUs worldwide over a 3-month period in 2014. Based on Kidney Disease: Improving Global Outcomes criteria, stage 2 or 3 AKI occurring within the first 7 days in the ICU was classified as severe. Increases in morbidity and mortality associated with AKI were assessed as well.

Stage 1 or higher AKI developed in 26.9% of patients, while 11.6% met criteria for severe AKI. Mortality within 28 days was 11.0% in patients with severe AKI, compared to 2.5% in those without severe AKI: adjusted odds ratio 1.77. Patients with severe AKI were also more likely to require mechanical ventilation and renal replacement therapy.

Mortality increased in stepwise fashion with the maximum stage of AKI. Assessing AKI based on plasma creatinine alone missed the diagnosis of AKI in 67.2% of patients with low urine output. The prevalence of AKI increased from 14.5% on ICU day 1 to 20.4% on day 7.

The data show the high rate and clinical impact of AKI in pediatric ICU settings. Severe AKI is associated with an increased risk of adverse outcomes, prolonged ICU stay, and death. In contrast to the confounding effect of chronic diseases in adults, AKI in children may be a key contributor to increased morbidity and mortality [Kaddourah A, et al. Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med 2016; DOI: 10.1056/NEJMoa1611391].