AKI in Hospitalized Children
Top Cited Papers
Open Access
- 1 April 2015
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Journal of the American Society of Nephrology
- Vol. 10 (4), 554-561
- https://doi.org/10.2215/cjn.01900214
Abstract
Background and objectives 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. Design, setting, participants, & measurements 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%; PPConclusions 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.Keywords
This publication has 25 references indexed in Scilit:
- World Incidence of AKIClinical Journal of the American Society of Nephrology, 2013
- Impact of real-time electronic alerting of acute kidney injury on therapeutic intervention and progression of RIFLE class*Critical Care Medicine, 2012
- Update on acute kidney injury in the neonateCurrent Opinion in Pediatrics, 2012
- Acute Kidney Injury and Increasing Nephrotoxic-Medication Exposure in Noncritically-Ill ChildrenClinical Journal of the American Society of Nephrology, 2011
- Acute kidney injury leads to pediatric patient mortalityNature Reviews Nephrology, 2010
- Acute kidney injury in non-critically ill children treated with aminoglycoside antibiotics in a tertiary healthcare centre: a retrospective cohort studyNephrology Dialysis Transplantation, 2010
- Ascertainment and Epidemiology of Acute Kidney Injury Varies with Definition InterpretationClinical Journal of the American Society of Nephrology, 2008
- Modified RIFLE criteria in critically ill children with acute kidney injuryKidney International, 2007
- Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injuryCritical Care, 2007
- 3–5 year longitudinal follow-up of pediatric patients after acute renal failureKidney International, 2006