The Incidence and Outcomes of Acute Kidney Disease in Critically Ill Children

Key Points Major adverse kidney events are common in children who develop acute kidney disease in the intensive care unit. Acute kidney disease criteria identify critically ill children at risk for major adverse kidney event who do not meet AKI or CKD criteria. Background Acute kidney disease (AKD) includes abnormalities of kidney function present for <90 days. AKI is defined as a subset of AKD with onset within 7 days. There are scant data on the rates of AKD in children and its association with outcomes. Our primary objective was to examine the rates of AKD with and without AKI and compare major adverse events in children in the pediatric intensive care unit (PICU). Methods This is a retrospective cohort study of patients aged 18 years or younger who were admitted to a quaternary care PICU between 2009 and 2016 using the high-density pediatric database. All patients included in the primary analysis had a known baseline serum creatinine. Patients who had a baseline eGFR <60 ml/min per 1.73 m 2 or a history of dialysis dependence or kidney transplant were excluded. AKI and AKD were defined by Kidney Disease Improving Global Outcomes definitions. Major adverse kidney events at 90 days (MAKE-90) was defined as a composite outcome of death, dialysis, or persistent kidney dysfunction 90 days after PICU admission. Results Among 5922 children included in this study, 1199 (20.2%) had AKD, of which 1092 (91%) had AKD with AKI and 107 (8.9%) had AKD without AKI. MAKE-90 occurred in 26% (308/1199) of those with AKD compared with 3.6% (172/4723) without ( P ≤ 0.001). MAKE-90 occurred in 26% (279/1092) of AKD with AKI and 27% (29/107) of AKD without AKI. After adjusting for age, sex, and illness severity, compared with patients who had no AKD, patients with AKD with AKI (adjusted odds ratio, 14.39; 95% confidence interval, 11.06 to 18.72), and patients with AKD without AKI (adjusted odds ratio, 7.83; 95% confidence interval, 4.54 to 13.51) had a greater odds of MAKE-90. Conclusions More than a quarter of pediatric critically ill patients with AKD develop MAKE-90. Even in the absence of AKI, AKD is an independent risk factor for MAKE-90.