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Kidney Week

Abstract: FR-PO012

Underreported AKI in Pediatric Intensive Care: Incidence, Risk Factors, and Outcomes

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Keshwah, Sunil Paul, University of Chicago Comer Children''s Hospital, Chicago, Illinois, United States
  • Mahavadi, Vidya, University of Chicago Comer Children''s Hospital, Chicago, Illinois, United States
  • Hashmat, Shireen, University of Chicago Comer Children''s Hospital, Chicago, Illinois, United States
Background

Acute kidney injury (AKI) is increasingly recognized in critically ill pediatric patients. AKI is frequently underreported leading to the potential for increased morbidity and mortality associated with this disorder. Our study seeks to identify the incidence, risk factors, and outcomes of patients with undocumented AKI in the pediatric critical care population.

Methods

We conducted a retrospective chart review of patients admitted to the PICU at Comer Children’s Hospital between January 1, 2017-December 31, 2017. Patients with a rise in serum creatinine (SCr) levels consistent with the KDIGO AKI criteria were considered to have AKI. Patients with a physician note in their electronic medical record (EMR) containing the terms “AKI”, Acute Kidney Injury” or “Acute Renal Failure” were labeled as having “Documented AKI”. The primary outcome of interest was a comparison between AKI patients with and without EMR documentation of disease. All statistical analyses were performed using STATA software with a p-value of < 0.05 considered statistically significant.

Results

AKI was identified in 8.3% of the total population, with 71% of these patients not having any documentation of AKI in the EMR. There was a significant increase in documentation of AKI in patients with oliguria, nephrotoxic medication and inotropic/vasopressor exposure. Patients with documented AKI had a statistically significant increase in their median length of PICU admission (13.5 days vs 2 days, p=0.00) and median length of mechanical ventilation (12.94 days vs 6.84 days, p=0.034). A nephrology consultation was placed in 2.2% of patients with undocumented AKI.

Conclusion

Our data shows that a substantial number of all AKI diagnosis were not documented in the EMR. Of note, this does not indicate that the provider failed to recognize AKI, but it does represent a deficiency to convey to the medical team the occurrence of this disorder. There were also a significant number of patients with AKI that did not receive a nephrology consultation, an intervention that has been shown to reduce morbidity and mortality of AKI.

Clinical Outcomes
OutcomeDocumented
AKI (n=38)
Undocumented AKI (n=93)p-value
Mortality
(Within 90 days)
0 (0%)6 (6.5%)0.109
Length of PICU Admission,
Median [IQR]
13.5 [3, 20]2 [1, 8]0.000
Length of Mechanical Ventilation,
Mean (+/- SD)
12.94 (+/- 15.44)
6.84 (+/- 6.96)
0.034