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Kidney Week

Abstract: PO1952

Diuretic Use, Comorbidity, and Length of Stay in Pediatric AKI

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Carter, Jessamyn S., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Klamer, Brett, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Spencer, John David, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Mohamed, Tahagod, Nationwide Children's Hospital, Columbus, Ohio, United States
Background

Acute kidney injury (AKI) and fluid overload (FO) both have well known negative effects on morbidity and mortality in many populations. The combination of AKI and FO is associated with synergistically worse outcomes in critically ill children. Diuretic use in management of AKI and FO has been studied in adults with widely varied outcomes ranging from improved mortality to no significant change to increased comorbidity such as prolonged mechanical ventilation. Therefore utility of diuretics remains unclear, and their use in pediatric patients with AKI has not been characterized.

Methods

The Pediatric Hospital Information System (PHIS) database was queried for patients with diagnosis of AKI from January 2015 to December 2019 with admission LOS <15 days. Those <1 or >18 years of age were excluded. ICD codes were used to discern complex chronic conditions (CCCs) as well as acute comorbidities. Daily medication exposure was used to determine diuretic use. LOS in both the ICU and the inpatient floor was assessed. CCCs of interest were chronic kidney disease (CKD), kidney transplant, and heart failure. Measured comorbidities included: shock, mechanical ventilation, hypoxemia, fluid overload, ascites, edema, and oligoanuria. Numeric data were summarized as medians and IQRs and categorical data as frequency and percent. Associations between diuretic use and comorbidity was assessed by Wilcoxon’s rank-sum test and Fisher’s exact test. Length of stay was then assessed by longitudinal regression.

Results

There were 5490 encounters for analysis with diuretic use in 951. Demographics were similar between groups. Those with CKD or heart failure were more likely to receive diuretics, while those with kidney transplant status were less likely to receive diuretics. LOS was 1.67 days longer in those who received diuretics despite adjustment for age, gender, and illness severity including CCCs. All acute comorbidities were increased in those who received diuretics.

Conclusion

Children with underlying CCCs were more likely to receive diuretics and to have longer LOS. Comorbidities and LOS were also increased in children with AKI who received diuretics regardless of disease severity. This is clinically important as diuretic use may be a corollary for worse outcomes and increased costs. Due to database limitations, temporal association is unknown and further study is needed.