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

Background: Acute kidney disease (AKD) includes abnormalities of kidney function present for <90 days. Acute kidney injury (AKI) is defined as a subset of AKD, with onset within seven days. There is 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 (MAKE) in children in the pediatric intensive care unit (PICU).

Methods: This is a retrospective cohort study of patients ≤18 years old 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 estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 or a history of dialysis dependence or kidney transplant were excluded. AKI and AKD were defined by Kidney Disease: Improving Global Outcomes definitions. MAKE-90 was defined as a composite outcome of death, dialysis, or persistent kidney dysfunction 90 days after PICU admission.

Results: Among 5,922 children included in this study, 1,199 (20.2%) had AKD, of which 1,092 (91%) had AKD with AKI and 107 (8.9%) had AKD without AKI. MAKE-90 occurred in 26% (308/1,199) of those with AKD compared to 3.6% (172/4723) without (p=<0.001). MAKE-90 occurred in 26% (279/1,092) of AKD with AKI and 27% (29/107) of AKD without AKI. After adjusting for age, sex, and illness severity, compared to patients that had no AKD, patients with AKD with AKI (aOR: 14.39, 95% CI: 11.06-18.72) and patients with AKD without AKI (aOR: 7.83, 95% CI: 4.54-13.51) 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.