Faculty Collaboration Database

Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults. N Engl J Med 2017 Jan 05;376(1):11-20

Date

12/14/2016

Pubmed ID

27959707

Pubmed Central ID

PMC5322803

DOI

10.1056/NEJMoa1611391

Scopus ID

2-s2.0-85008352251 (requires institutional sign-in at Scopus site)   681 Citations

Abstract

BACKGROUND: The epidemiologic characteristics of children and young adults with acute kidney injury have been described in single-center and retrospective studies. We conducted a multinational, prospective study involving patients admitted to pediatric intensive care units to define the incremental risk of death and complications associated with severe acute kidney injury.

METHODS: We used the Kidney Disease: Improving Global Outcomes criteria to define acute kidney injury. Severe acute kidney injury was defined as stage 2 or 3 acute kidney injury (plasma creatinine level ≥2 times the baseline level or urine output <0.5 ml per kilogram of body weight per hour for ≥12 hours) and was assessed for the first 7 days of intensive care. All patients 3 months to 25 years of age who were admitted to 1 of 32 participating units were screened during 3 consecutive months. The primary outcome was 28-day mortality.

RESULTS: A total of 4683 patients were evaluated; acute kidney injury developed in 1261 patients (26.9%; 95% confidence interval [CI], 25.6 to 28.2), and severe acute kidney injury developed in 543 patients (11.6%; 95% CI, 10.7 to 12.5). Severe acute kidney injury conferred an increased risk of death by day 28 after adjustment for 16 covariates (adjusted odds ratio, 1.77; 95% CI, 1.17 to 2.68); death occurred in 60 of the 543 patients (11.0%) with severe acute kidney injury versus 105 of the 4140 patients (2.5%) without severe acute kidney injury (P<0.001). Severe acute kidney injury was associated with increased use of mechanical ventilation and renal-replacement therapy. A stepwise increase in 28-day mortality was associated with worsening severity of acute kidney injury (P<0.001 by log-rank test). Assessment of acute kidney injury according to the plasma creatinine level alone failed to identify acute kidney injury in 67.2% of the patients with low urine output.

CONCLUSIONS: Acute kidney injury is common and is associated with poor outcomes, including increased mortality, among critically ill children and young adults. (Funded by the Pediatric Nephrology Center of Excellence at Cincinnati Children's Hospital Medical Center and others; AWARE ClinicalTrials.gov number, NCT01987921 .).

Author List

Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL, AWARE Investigators

Author

Christina Metcalf Mckinney MD Adjunct Instructor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Kidney Injury
Adolescent
Adult
Child
Child, Preschool
Creatinine
Critical Illness
Female
Humans
Infant
Intensive Care Units, Pediatric
Length of Stay
Male
Prospective Studies
Renal Replacement Therapy
Respiration, Artificial
Risk Factors
Severity of Illness Index
Treatment Outcome
Young Adult