Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults
Open accessAbstract
BACKGROUND: The epidemiologic characteristics of children and young adults with acute kidney injury have been described in single-center and retrospective studies. We conducted a multinational, prospective study involving patients admitted to pediatric intensive care units to define the incremental risk of death and complications associated with severe acute kidney injury. METHODS: We used the Kidney Disease: Improving Global Outcomes criteria to define acute kidney injury. Severe acute kidney injury was defined as stage 2 or 3 acute kidney injury (plasma creatinine level ≥2 times the baseline level or urine output <0.5 ml per kilogram of body weight per hour for ≥12 hours) and was assessed for the first 7 days of intensive care. All patients 3 months to 25 years of age who were admitted to 1 of 32 participating units were screened during 3 consecutive months. The primary outcome was 28-day mortality. RESULTS: A total of 4683 patients were evaluated; acute kidney injury developed in 1261 patients (26.9%; 95% confidence interval [CI], 25.6 to 28.2), and severe acute kidney injury developed in 543 patients (11.6%; 95% CI, 10.7 to 12.5). Severe acute kidney injury conferred an increased risk of death by day 28 after adjustment for 16 covariates (adjusted odds ratio, 1.77; 95% CI, 1.17 to 2.68); death occurred in 60 of the 543 patients (11.0%) with severe acute kidney injury versus 105 of the 4140 patients (2.5%) without severe acute kidney injury (P<0.001). Severe acute kidney injury was associated with increased use of mechanical ventilation and renal-replacement therapy. A stepwise increase in 28-day mortality was associated with worsening severity of acute kidney injury (P<0.001 by log-rank test). Assessment of acute kidney injury according to the plasma creatinine level alone failed to identify acute kidney injury in 67.2% of the patients with low urine output. CONCLUSIONS: Acute kidney injury is common and is associated with poor outcomes, including increased mortality, among critically ill children and young adults. (Funded by the Pediatric Nephrology Center of Excellence at Cincinnati Children's Hospital Medical Center and others; AWARE ClinicalTrials.gov number, NCT01987921 .).
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Up to 20% of AKI patients are diagnosed based on the urine output criteria alone.
“Up to 20% of AKI patients are diagnosed based on the urine output criteria alone [20]”
From Machine learning model for early prediction of acute kidney injury (AKI) in pediatric critical care (2021) · cites this paper as [20]
The Results section (Comparison of Plasma Creatinine Level and Urine Output in Defining Acute Kidney Injury; page unavailable) supports diagnosis by urine-output criteria alone: 355 patients meeting those criteria would have been missed using plasma creatinine alone. It does not support the stated upper limit of 20%; among patients with data for both measures, those 355 represent about 32.5% of the 1,093 patients meeting either criterion. (LLM, conf=0.88)
Experimental — accuracy not yet measuredEarly improvements in renal function after AKI may lead to better outcomes.
“some studies have shown that early improvements in renal function after AKI may lead to better outcomes [1, 5, 7].”
From Machine learning model for early prediction of acute kidney injury (AKI) in pediatric critical care (2021) · cites this paper as [1]
The Results sections on AKI progression and risk of death report worsening AKI and an association between greater severity and mortality. They do not compare patients whose renal function improved early after AKI with those whose function did not improve. Searches for recovery, resolution, and early improvement found no passage addressing that claim; the Discussion also cautions against causal conclusions. (LLM, conf=0.76)
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Machine learning model for early prediction of acute kidney injury (AKI) in pediatric critical care
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“Up to 20% of AKI patients are diagnosed based on the urine output criteria alone [20], and the lack of urine criteria may have resulted in lower AKI rates than previously described.”
BackgroundAlten, J. A., Cooper, D. S., Blinder, J. J., Selewski, D. T., Tabbutt, S., Sasaki, J., Gaies, M. G., Bertrandt, R. A., Smith, A. H., Reichle, G., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005165 · Cited by 126 · see citing works
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- Authors
- Kaddourah, A., Basu, R. K., Bagshaw, S. M., & Goldstein, S. L.
- Affiliations
- Cincinnati Children's Hospital Medical Center (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2017-01-05
- Volume
- 376
- Issue
- 1
- Pages
- 11-20
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC5322803
- OpenAlex
- W2550172802
- Cited by
- 1,075
- References
- 28
- Citations by year
- 2026: 99 · 2025: 105 · 2024: 109 · 2023: 137 · 2022: 129 · 2021: 144 · 2020: 113 · 2019: 93 · 2018: 95 · 2017: 46 · 2016: 2 · 2015: 1
- FWCI
- 78.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- UNSWorks (UNSW Sydney) (submittedVersion, cc-by-nc-nd)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- Funders
- Cincinnati Children's Hospital Medical Center
- National Institutes of Health (UL1TR001425)
- National Institute of Diabetes and Digestive and Kidney Diseases (P50DK096418)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- acute kidney injury, pediatric intensive care, critically ill children, young adults, 28-day mortality, acute kidney injury severity, serum creatinine, urine output, mechanical ventilation, renal replacement therapy, AKI risk factors, AKI outcomes, AKI epidemiology, AKI complications
- MeSH terms
- Adolescent, Adult, Child, Child, Preschool, Creatinine, Female, Humans, Infant, Length of Stay, Male, Prospective Studies, Respiration, Artificial, Risk Factors, Severity of Illness Index, Intensive Care Units, Pediatric, Critical Illness, Treatment Outcome, Renal Replacement Therapy, Young Adult, Acute Kidney Injury
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