Incidence of acute kidney injury in hospitalized children.
OBJECTIVE
To determine the incidence and outcome of acute kidney injury (AKI) in hospitalized patients.


METHODS
Prospective, observational.


METHODS
Tertiary care center in North India.


METHODS
Inpatients, 1 month to 18 yrs.


METHODS
None.


METHODS
Incidence of AKI based on the serum creatinine criteria proposed by the AKI Network.


RESULTS
During February to September 2008, thirty nine of 108 (36.1%) critically ill patients and 34 of 378 (9.0%) patients who were not critically ill developed AKI (P<0.001); the respective incidence densities were 45.1 and 11.7 cases/1000 patient days, respectively. The maximal stage of AKI was stage 1 in 48 (65.8%) patients, stage 2 in 13 (17.8%) and stage 3 in 12 (16.4%) patients; 11 (15.1%) required dialysis. Patients with AKI had a significantly longer duration of hospital stay (9 days vs 7 days, P<0.02) and higher mortality (37% vs 8.7%; hazard ratio, HR 2.73; 95% CI 1.64, 4.54). Independent risk factors for AKI were young age (HR 0.89; 95% CI 0.83, 0.95), shock (HR 2.65; 95% CI 1.32, 5.31), sepsis (HR 3.64; 95% CI 2.20, 6.01), and need for mechanical ventilation (2.18; 95% CI 1.12, 4.26). Compared to patients without AKI, the mortality was higher for AKI stage 2 (HR 5.18; 95% CI 2.59, 10.38) and stage 3 (HR 4.34; 95% CI 2.06, 9.16). Shock was an independent risk factor for mortality (HR 10.7; 95% CI 4.96, 22.98).


CONCLUSIONS
AKI is common in critically ill children, especially younger patients with septicemia and shock, and results in increased hospital stay and high mortality.
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Poonam
P
Mehta
Aditi
A
Sinha
Abdus
A
Sami
Pankaj
P
Hari
Mani
M
Kalaivani
Ashima
A
Gulati
Madhulika
M
Kabra
Sushil K
SK
Kabra
Rakesh
R
Lodha
Arvind
A
Bagga
D000208:Acute Disease / Q000453:epidemiology; D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000401:mortality; D000293:Adolescent; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data*; D002675:Child, Preschool; D016638:Critical Illness / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007673:Kidney Cortex Necrosis; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome