title: The epidemiology and prognostic factors of mortality in critically ill children with acute kidney injury in Taiwan.
abstract: The incidence of acute kidney injury (AKI) in critically ill children varies among countries. Here we used claims data from the Taiwanese National Health Insurance program from 2006 to 2010 to investigate the epidemiological features and identify factors that predispose individuals to developing AKI and mortality in critically ill children with AKI. Of 60,338 children in this nationwide cohort, AKI was identified in 850, yielding an average incidence rate of 1.4%. Significant independent risk factors for AKI were the use of extracorporeal membrane oxygenation, mechanical ventilation or vasopressors, intrinsic renal diseases, sepsis, and age more than 1 year. Overall, of the AKI cases, 46.5% were due to sepsis, 36.1% underwent renal replacement therapy, and the mortality rate was 44.2%. Multivariate analysis showed that the use of vasopressors, mechanical ventilation, and hemato-oncological disorders were independent predictors of mortality in AKI patients. Thirty-two of the 474 patients who survived had progression to chronic kidney disease or end-stage renal disease. Thus, although not common, AKI in critically ill children still has a high mortality rate associated with a variety of factors. Long-term close follow-up to prevent progressive chronic kidney disease in survivors of critical illnesses with AKI is mandatory.
authors.affiliation: 1] Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan [2] School of Medicine, National Yang-Ming University, Taipei,Taiwan.
authors.forename: Jei-Wen
authors.initials: JW
authors.lastname: Chang
authors.affiliation: 1] Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan [2] School of Medicine, National Yang-Ming University, Taipei,Taiwan.
authors.forename: Mei-Jy
authors.initials: MJ
authors.lastname: Jeng
authors.affiliation: 1] Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan [2] School of Medicine, National Yang-Ming University, Taipei,Taiwan.
authors.forename: Ling-Yu
authors.initials: LY
authors.lastname: Yang
authors.affiliation: 1] School of Medicine, National Yang-Ming University, Taipei,Taiwan [2] Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.affiliation: Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Shu-Chiung
authors.initials: SC
authors.lastname: Chiang
authors.affiliation: 1] Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan [2] School of Medicine, National Yang-Ming University, Taipei,Taiwan.
authors.forename: Wen-Jue
authors.initials: WJ
authors.lastname: Soong
authors.affiliation: 1] Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan [2] School of Medicine, National Yang-Ming University, Taipei,Taiwan.
authors.forename: Keh-Gong
authors.initials: KG
authors.lastname: Wu
authors.affiliation: 1] Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan [2] School of Medicine, National Yang-Ming University, Taipei,Taiwan.
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Lee
authors.affiliation: 1] Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan [2] School of Medicine, National Yang-Ming University, Taipei,Taiwan.
authors.forename: Hsin-Hui
authors.initials: HH
authors.lastname: Wang
authors.affiliation: 1] Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan [2] School of Medicine, National Yang-Ming University, Taipei,Taiwan.
authors.forename: Chia-Feng
authors.initials: CF
authors.lastname: Yang
authors.affiliation: 1] School of Medicine, National Yang-Ming University, Taipei,Taiwan [2] Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Hsin-Lin
authors.initials: HL
authors.lastname: Tsai
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D018450:Disease Progression; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D019337:Hematologic Neoplasms / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D011379:Prognosis; D017582:Renal Replacement Therapy; D012121:Respiration, Artificial; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents