Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults
Most children with serious acute illness do not have underlying chronic conditions. This prospective study involving patients in pediatric intensive care units showed that acute kidney injury is common and is associated with poor outcomes, including increased mortality. Epidemiologic studies involvi...
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| Vydáno v: | The New England journal of medicine Ročník 376; číslo 1; s. 11 - 20 |
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| Hlavní autoři: | , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
| Vydáno: |
United States
Massachusetts Medical Society
05.01.2017
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| Témata: | |
| ISSN: | 0028-4793, 1533-4406, 1533-4406 |
| On-line přístup: | Získat plný text |
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| Abstract | Most children with serious acute illness do not have underlying chronic conditions. This prospective study involving patients in pediatric intensive care units showed that acute kidney injury is common and is associated with poor outcomes, including increased mortality.
Epidemiologic studies involving adults have shown that acute kidney injury is associated with increased mortality, prolonged mechanical ventilation, and prolonged length of stay in intensive care units (ICUs).
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A multinational, prospective study involving 1802 adults
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initiated the use of Kidney Disease: Improving Global Outcomes (KDIGO) guidelines to describe the epidemiology of acute kidney injury; the guidelines
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define and stage acute kidney injury according to the plasma creatinine level and urine output (Table S1 in the Supplementary Appendix, available with the full text of this article at NEJM.org). That study showed graded associations between the severity of acute kidney injury and . . . |
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| AbstractList | Most children with serious acute illness do not have underlying chronic conditions. This prospective study involving patients in pediatric intensive care units showed that acute kidney injury is common and is associated with poor outcomes, including increased mortality.
Epidemiologic studies involving adults have shown that acute kidney injury is associated with increased mortality, prolonged mechanical ventilation, and prolonged length of stay in intensive care units (ICUs).
1
–
3
A multinational, prospective study involving 1802 adults
3
initiated the use of Kidney Disease: Improving Global Outcomes (KDIGO) guidelines to describe the epidemiology of acute kidney injury; the guidelines
4
define and stage acute kidney injury according to the plasma creatinine level and urine output (Table S1 in the Supplementary Appendix, available with the full text of this article at NEJM.org). That study showed graded associations between the severity of acute kidney injury and . . . BackgroundThe 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.MethodsWe 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.ResultsA 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.ConclusionsAcute 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.) 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. 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. 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. 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 .). 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.BACKGROUNDThe 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.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.METHODSWe 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.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.RESULTSA 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.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 .).CONCLUSIONSAcute 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 .). |
| Author | Kaddourah, Ahmad Basu, Rajit K Bagshaw, Sean M Goldstein, Stuart L |
| Author_xml | – sequence: 1 givenname: Ahmad surname: Kaddourah fullname: Kaddourah, Ahmad organization: From the Center for Acute Care Nephrology (A.K., R.K.B., S.L.G.) and the Division of Critical Care (R.K.B.), Cincinnati Children’s Hospital Medical Center, Cincinnati; Sidra Medical and Research Center, Doha, Qatar (A.K.); and the Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (S.M.B.) – sequence: 2 givenname: Rajit K surname: Basu fullname: Basu, Rajit K organization: From the Center for Acute Care Nephrology (A.K., R.K.B., S.L.G.) and the Division of Critical Care (R.K.B.), Cincinnati Children’s Hospital Medical Center, Cincinnati; Sidra Medical and Research Center, Doha, Qatar (A.K.); and the Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (S.M.B.) – sequence: 3 givenname: Sean M surname: Bagshaw fullname: Bagshaw, Sean M organization: From the Center for Acute Care Nephrology (A.K., R.K.B., S.L.G.) and the Division of Critical Care (R.K.B.), Cincinnati Children’s Hospital Medical Center, Cincinnati; Sidra Medical and Research Center, Doha, Qatar (A.K.); and the Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (S.M.B.) – sequence: 4 givenname: Stuart L surname: Goldstein fullname: Goldstein, Stuart L organization: From the Center for Acute Care Nephrology (A.K., R.K.B., S.L.G.) and the Division of Critical Care (R.K.B.), Cincinnati Children’s Hospital Medical Center, Cincinnati; Sidra Medical and Research Center, Doha, Qatar (A.K.); and the Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (S.M.B.) |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27959707$$D View this record in MEDLINE/PubMed |
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| Snippet | Most children with serious acute illness do not have underlying chronic conditions. This prospective study involving patients in pediatric intensive care units... The epidemiologic characteristics of children and young adults with acute kidney injury have been described in single-center and retrospective studies. We... BackgroundThe epidemiologic characteristics of children and young adults with acute kidney injury have been described in single-center and retrospective... |
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| SubjectTerms | Acute Kidney Injury - complications Acute Kidney Injury - epidemiology Acute Kidney Injury - mortality Acute Kidney Injury - therapy Adolescent Adult Body weight Child Child, Preschool Children Children & youth Creatinine Creatinine - blood Critical care Critical Illness Death Epidemiology Female Humans Infant Intensive care units Intensive Care Units, Pediatric Kidney diseases Kidneys Length of Stay Male Mechanical ventilation Mortality Nephrology Pediatrics Prospective Studies Renal Replacement Therapy Respiration, Artificial Risk Factors Severity of Illness Index Treatment Outcome Urine Young Adult Young adults |
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| Title | Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults |
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