title: AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions.
abstract: OBJECTIVE
  Although several standardized definitions for AKI have been developed, no consensus exists regarding which to use in children. This study applied the Pediatric RIFLE (pRIFLE), AKI Network (AKIN), and Kidney Disease Improving Global Outcomes (KDIGO) criteria to an anonymized cohort of hospitalizations extracted from the electronic medical record to compare AKI incidence and outcomes in intensive care unit (ICU) and non-ICU pediatric populations.
  
  
  METHODS
  Observational, electronic medical record-enabled study of 14,795 hospitalizations at the Lucile Packard Children's Hospital between 2006 and 2010. AKI and AKI severity stage were defined by the pRIFLE, AKIN, and KDIGO definitions according to creatinine change criteria; urine output criteria were not used. The incidences of AKI and each AKI stage were calculated for each classification system. All-cause, in-hospital mortality and total hospital length of stay (LOS) were compared at each subsequent AKI stage by Fisher exact and Kolmogorov-Smirnov tests, respectively.
  
  
  RESULTS
  AKI incidences across the cohort according to pRIFLE, AKIN, and KDIGO were 51.1%, 37.3%, and 40.3%. Mortality was higher among patients with AKI across all definitions (pRIFLE, 2.3%; AKIN, 2.7%; KDIGO, 2.5%; P<0.001 versus no AKI [0.8%-1.0%]). Within the ICU, pRIFLE, AKIN, and KDIGO demonstrated progressively higher mortality at each AKI severity stage; AKI was not associated with mortality outside the ICU by any definition. Both in and outside the ICU, AKI was associated with significantly higher LOS at each AKI severity stage across all three definitions (P<0.001). Definitions resulted in differences in diagnosis and staging of AKI; staging agreement ranged from 76.7% to 92.5%.
  
  
  CONCLUSIONS
  Application of the three definitions led to differences in AKI incidence and staging. AKI was associated with greater mortality and LOS in the ICU and greater LOS outside the ICU. All three definitions demonstrated excellent interstage discrimination. While each definition offers advantages, these results underscore the need to adopt a single, universal AKI definition.
authors: Department of Pediatrics, Stanford University, Stanford, California; suthersm@stanford.edu.
authors: Scott M
authors: SM
authors: Sutherland
authors: SRI International, Menlo Park, California; and.
authors: John J
authors: JJ
authors: Byrnes
authors: SRI International, Menlo Park, California; and.
authors: Manish
authors: M
authors: Kothari
authors: Department of Pediatrics, Stanford University, Stanford, California;
authors: Christopher A
authors: CA
authors: Longhurst
authors: Department of Pediatrics, Stanford University, Stanford, California;
authors: Sanjeev
authors: S
authors: Dutta
authors: SRI International, Menlo Park, California; and.
authors: Pablo
authors: P
authors: Garcia
authors: Center for Acute Care Nephrology, Cincinnati Children's Hospital, Cincinnati, Ohio.
authors: Stuart L
authors: SL
authors: Goldstein
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D000293:Adolescent; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D032921:Consensus; D003404:Creatinine / Q000097:blood; D057286:Electronic Health Records; D005260:Female; D005919:Glomerular Filtration Rate; D006305:Health Status Indicators; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007668:Kidney / Q000503:physiopathology; D007902:Length of Stay; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: acute renal failure; children; kidney failure; mortality
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