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Acute Kidney Injury Incidence in Noncritically Ill Hospitalized Children, Adolescents, and Young Adults: A Retrospective Observational Study.
Am J Kidney Dis 2016; 67(3):384-90AJ

Abstract

BACKGROUND

Acute kidney injury (AKI) has been characterized in high-risk pediatric hospital inpatients, in whom AKI is frequent and associated with increased mortality, morbidity, and length of stay. The incidence of AKI among patients not requiring intensive care is unknown.

STUDY DESIGN

Retrospective cohort study.

SETTING & PARTICIPANTS

13,914 noncritical admissions during 2011 and 2012 at our tertiary referral pediatric hospital were evaluated. Patients younger than 28 days or older than 21 years of age or with chronic kidney disease (CKD) were excluded. Admissions with 2 or more serum creatinine measurements were evaluated.

FACTORS

Demographic features, laboratory measurements, medication exposures, and length of stay.

OUTCOME

AKI defined as increased serum creatinine level in accordance with KDIGO (Kidney Disease: Improving Global Outcomes) criteria. Based on time of admission, time interval requirements were met in 97% of cases, but KDIGO time window criteria were not strictly enforced to allow implementation using clinically obtained data.

RESULTS

2 or more creatinine measurements (one baseline before or during admission and a second during admission) in 2,374 of 13,914 (17%) patients allowed for AKI evaluation. A serum creatinine difference ≥0.3mg/dL or ≥1.5 times baseline was seen in 722 of 2,374 (30%) patients. A minimum of 5% of all noncritical inpatients without CKD in pediatric wards have an episode of AKI during routine hospital admission.

LIMITATIONS

Urine output, glomerular filtration rate, and time interval criteria for AKI were not applied secondary to study design and available data. The evaluated cohort was restricted to patients with 2 or more clinically obtained serum creatinine measurements, and baseline creatinine level may have been measured after the AKI episode.

CONCLUSIONS

AKI occurs in at least 5% of all noncritically ill hospitalized children, adolescents, and young adults without known CKD. Physicians should increase their awareness of AKI and improve surveillance strategies with serum creatinine measurements in this population so that exacerbating factors such as nephrotoxic medication exposures may be modified as indicated.

Authors+Show Affiliations

Department of Pediatrics, Vanderbilt University, Nashville, TN.Department of Pediatrics, Vanderbilt University, Nashville, TN.Department of Biostatistics, Vanderbilt University, Nashville, TN.Institute for Clinical and Translational Research, Vanderbilt University, Nashville, TN.Department of Pediatrics, Vanderbilt University, Nashville, TN.Department of Pediatrics, Vanderbilt University, Nashville, TN.Institute for Clinical and Translational Research, Vanderbilt University, Nashville, TN.Institute for Clinical and Translational Research, Vanderbilt University, Nashville, TN.Department of Biostatistics, Vanderbilt University, Nashville, TN.Department of Pediatrics, Vanderbilt University, Nashville, TN; Department of Medicine, Vanderbilt University, Nashville, TN. Electronic address: sara.van.driest@vanderbilt.edu.

Pub Type(s)

Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26319754

Citation

McGregor, Tracy L., et al. "Acute Kidney Injury Incidence in Noncritically Ill Hospitalized Children, Adolescents, and Young Adults: a Retrospective Observational Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 67, no. 3, 2016, pp. 384-90.
McGregor TL, Jones DP, Wang L, et al. Acute Kidney Injury Incidence in Noncritically Ill Hospitalized Children, Adolescents, and Young Adults: A Retrospective Observational Study. Am J Kidney Dis. 2016;67(3):384-90.
McGregor, T. L., Jones, D. P., Wang, L., Danciu, I., Bridges, B. C., Fleming, G. M., ... Van Driest, S. L. (2016). Acute Kidney Injury Incidence in Noncritically Ill Hospitalized Children, Adolescents, and Young Adults: A Retrospective Observational Study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 67(3), pp. 384-90. doi:10.1053/j.ajkd.2015.07.019.
McGregor TL, et al. Acute Kidney Injury Incidence in Noncritically Ill Hospitalized Children, Adolescents, and Young Adults: a Retrospective Observational Study. Am J Kidney Dis. 2016;67(3):384-90. PubMed PMID: 26319754.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute Kidney Injury Incidence in Noncritically Ill Hospitalized Children, Adolescents, and Young Adults: A Retrospective Observational Study. AU - McGregor,Tracy L, AU - Jones,Deborah P, AU - Wang,Li, AU - Danciu,Ioana, AU - Bridges,Brian C, AU - Fleming,Geoffrey M, AU - Shirey-Rice,Jana, AU - Chen,Lixin, AU - Byrne,Daniel W, AU - Van Driest,Sara L, Y1 - 2015/08/28/ PY - 2015/03/03/received PY - 2015/07/06/accepted PY - 2017/03/01/pmc-release PY - 2015/8/31/entrez PY - 2015/9/1/pubmed PY - 2016/7/9/medline KW - Acute kidney injury (AKI) KW - KDIGO AKI criteria KW - acute renal failure (ARF) KW - children, adolescents, young adults, electronic medical records (EMRs) KW - incidence KW - inpatient pediatrics KW - medication exposure KW - nephrotoxicity KW - serum creatinine SP - 384 EP - 90 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 67 IS - 3 N2 - BACKGROUND: Acute kidney injury (AKI) has been characterized in high-risk pediatric hospital inpatients, in whom AKI is frequent and associated with increased mortality, morbidity, and length of stay. The incidence of AKI among patients not requiring intensive care is unknown. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 13,914 noncritical admissions during 2011 and 2012 at our tertiary referral pediatric hospital were evaluated. Patients younger than 28 days or older than 21 years of age or with chronic kidney disease (CKD) were excluded. Admissions with 2 or more serum creatinine measurements were evaluated. FACTORS: Demographic features, laboratory measurements, medication exposures, and length of stay. OUTCOME: AKI defined as increased serum creatinine level in accordance with KDIGO (Kidney Disease: Improving Global Outcomes) criteria. Based on time of admission, time interval requirements were met in 97% of cases, but KDIGO time window criteria were not strictly enforced to allow implementation using clinically obtained data. RESULTS: 2 or more creatinine measurements (one baseline before or during admission and a second during admission) in 2,374 of 13,914 (17%) patients allowed for AKI evaluation. A serum creatinine difference ≥0.3mg/dL or ≥1.5 times baseline was seen in 722 of 2,374 (30%) patients. A minimum of 5% of all noncritical inpatients without CKD in pediatric wards have an episode of AKI during routine hospital admission. LIMITATIONS: Urine output, glomerular filtration rate, and time interval criteria for AKI were not applied secondary to study design and available data. The evaluated cohort was restricted to patients with 2 or more clinically obtained serum creatinine measurements, and baseline creatinine level may have been measured after the AKI episode. CONCLUSIONS: AKI occurs in at least 5% of all noncritically ill hospitalized children, adolescents, and young adults without known CKD. Physicians should increase their awareness of AKI and improve surveillance strategies with serum creatinine measurements in this population so that exacerbating factors such as nephrotoxic medication exposures may be modified as indicated. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/26319754/Acute_Kidney_Injury_Incidence_in_Noncritically_Ill_Hospitalized_Children_Adolescents_and_Young_Adults:_A_Retrospective_Observational_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(15)01037-9 DB - PRIME DP - Unbound Medicine ER -