Comparing pRIFLE, AKIN, KDIGO for AKI Diagnosis and Outcomes in Hospitalized Children

Background The existence of multiple diagnostic criteria results in inconsistencies in the reporting of incidence and outcomes of AKI in children, warranting the need for a single criterion. Materials and Methods We conducted a prospective observational cohort study in a tertiary care hospital, enrolling 502 children aged 1 month to 18 years. We compared the incidence and staging of AKI using serum creatinine (Scr)-based definitions from pRIFLE, AKIN, and KDIGO criteria. We also assessed AKI-associated mortality, need for kidney replacement therapy (KRT), and recovery of kidney function in each group. Results Among 502 children, AKI was identified in 12%, 11%, and 10.8%, respectively, using pRIFLE, AKIN, and KDIGO. All three criteria showed excellent agreement for Stage 1 AKI (κ > 0.98) and substantial agreement for Stages 2–3, with overall inter-definition concordance exceeding κ = 0.90. AKI was significantly associated with higher mortality (ORs 10.9–15.0; p < 0.001), with a consistent increase in KRT requirement with advancing AKI stage across all criteria (KRT requirement in Stage 3: >40% of patients with AKI; p < 0.05 for all definitions). The median AKI duration was 3 days, with ∼68% showing recovery of kidney function at discharge. Venn analysis showed that most cases were identified by all definitions, with pRIFLE detecting seven additional stage 1 AKI cases that did not translate to adverse outcomes. Conclusion All three definitions demonstrate excellent concordance and comparable clinical utility. AKI, irrespective of diagnostic criteria, is strongly associated with mortality and the need for KRT across all definitions.