title: Acute Kidney Injury Incidence in Noncritically Ill Hospitalized Children, Adolescents, and Young Adults: A Retrospective Observational Study.
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.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  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.
  
  
  METHODS
  Demographic features, laboratory measurements, medication exposures, and length of stay.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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: Department of Pediatrics, Vanderbilt University, Nashville, TN.
authors: Tracy L
authors: TL
authors: McGregor
authors: Department of Pediatrics, Vanderbilt University, Nashville, TN.
authors: Deborah P
authors: DP
authors: Jones
authors: Department of Biostatistics, Vanderbilt University, Nashville, TN.
authors: Li
authors: L
authors: Wang
authors: Institute for Clinical and Translational Research, Vanderbilt University, Nashville, TN.
authors: Ioana
authors: I
authors: Danciu
authors: Department of Pediatrics, Vanderbilt University, Nashville, TN.
authors: Brian C
authors: BC
authors: Bridges
authors: Department of Pediatrics, Vanderbilt University, Nashville, TN.
authors: Geoffrey M
authors: GM
authors: Fleming
authors: Institute for Clinical and Translational Research, Vanderbilt University, Nashville, TN.
authors: Jana
authors: J
authors: Shirey-Rice
authors: Institute for Clinical and Translational Research, Vanderbilt University, Nashville, TN.
authors: Lixin
authors: L
authors: Chen
authors: Department of Biostatistics, Vanderbilt University, Nashville, TN.
authors: Daniel W
authors: DW
authors: Byrne
authors: Department of Pediatrics, Vanderbilt University, Nashville, TN; Department of Medicine, Vanderbilt University, Nashville, TN. Electronic address: sara.van.driest@vanderbilt.edu.
authors: Sara L
authors: SL
authors: Van Driest
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003404:Creatinine / Q000032:analysis*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D007297:Inpatients / Q000706:statistics & numerical data; D007677:Kidney Function Tests / Q000379:methods; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D003404:Creatinine
keywords: Acute kidney injury (AKI); KDIGO AKI criteria; acute renal failure (ARF); children, adolescents, young adults, electronic medical records (EMRs); incidence; inpatient pediatrics; medication exposure; nephrotoxicity; serum creatinine