Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population

Purpose Acute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney Disease: Improving Global Outcomes (KDIGO) AKI working group has proposed a standardized definition of AKI. Utilizing routinely available clinical d...

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Bibliographic Details
Published in:Intensive care medicine Vol. 40; no. 10; pp. 1481 - 1488
Main Authors: Selewski, David T., Cornell, Timothy T., Heung, Michael, Troost, Jonathan P., Ehrmann, Brett J., Lombel, Rebecca M., Blatt, Neal B., Luckritz, Kera, Hieber, Sue, Gajarski, Robert, Kershaw, David B., Shanley, Thomas P., Gipson, Debbie S.
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2014
Springer
Springer Nature B.V
Subjects:
Acute Kidney Injury - classification
Acute Kidney Injury - epidemiology
Acute Kidney Injury - mortality
Adolescent
Analysis
Anesthesiology
Child
Child, Preschool
Children
Chronic kidney failure
Creatinine
Creatinine - blood
Critical care
Critical Care Medicine
Critical Illness
Emergency Medicine
Female
Health aspects
Hospital Mortality
Hospitals
Humans
Incidence
Infant
Infant, Newborn
Injuries
Intensive
Intensive care
Intensive Care Units, Pediatric
Kidney diseases
Kidney transplants
Length of Stay
Linear Models
Male
Medicine
Medicine & Public Health
Michigan
Mortality
Multivariate Analysis
Nephrology
Original
Outcome Assessment (Health Care)
Pain Medicine
Patient Discharge - statistics & numerical data
Patients
Pediatric intensive care
Pediatrics
Pneumology/Respiratory System
Respiration, Artificial - statistics & numerical data
Retrospective Studies
Severity of Illness Index
Ventilators
Michigan
Ann Arbor Michigan
United States > US
Pediatric cardiac intensive care
KDIGO
Pediatric intensive care
Acute kidney injury
ISSN:0342-4642, 1432-1238, 1432-1238
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Summary:Purpose Acute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney Disease: Improving Global Outcomes (KDIGO) AKI working group has proposed a standardized definition of AKI. Utilizing routinely available clinical data, we evaluated the KDIGO AKI criteria and the relationship of AKI with relevant outcomes in a single center tertiary pediatric intensive care (PICU) and cardiac intensive care unit (CICU) population. Methods The University of Michigan Pediatric Critical Care Database was probed for all discharges from the pediatric intensive care and cardiac intensive care units between July 2011 and October 2013 ( N  = 4,645). The KDIGO serum creatinine (SCr)-based criteria staged AKI with the modification that a minimum SCr of greater than 0.5 mg/dL was required to be classified as AKI. Exclusion: end-stage renal disease, new renal transplant, missing PRISM III data, or no measured Cr during intensive care unit (ICU) admission ( N  = 1,636). Results AKI occurred in 737 (24.5 %, stage 1 = 193, stage 2 = 189, and stage 3 = 355) of 3,009 discharges (PICU N  = 1,870, CICU N  = 1,139) that included 2,415 patients. In multivariate analysis AKI was associated with increased ICU length of stay (LOS) in hours (stage I β  = 42.2, p  = 0.024, II β  = 74.1, p  = 0.003, III β  = 215.8, p  < 0.001). Multivariate analysis showed that AKI was associated with increased odds of ICU mortality (OR 3.4, 95 % CI 2.0–6.0) and increased length of mechanical ventilation among those requiring mechanical ventilation ( β  = 2.3 days, p  < 0.001). Conclusions Using the KDIGO criteria to define AKI, we observed a high prevalence of AKI among critically ill children. Worsening stages of AKI were associated with increased ICU LOS, and AKI was independently associated with prolonged mechanical ventilation and increased mortality. The KDIGO criteria describe clinically relevant AKI in a broad pediatric critical care population.
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ISSN:0342-4642
1432-1238
1432-1238
DOI:10.1007/s00134-014-3391-8