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Kidney Week

Abstract: TH-PO515

Epidemiology and Outcome of AKI in Hospitalised Children in Australia

Session Information

  • Pediatric Nephrology - I
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Didsbury, Madeleine S., Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia
  • Gelbart, Ben, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  • Summers, Peter R., Centre for Health Analytics, The Royal Children's Hospital, Melbourne, Victoria, Australia
  • Cheng, Daryl R., Centre for Health Analytics, The Royal Children's Hospital, Melbourne, Victoria, Australia
  • Forbes, Thomas A., Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia
  • Quinlan, Catherine, Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia
  • Kausman, Joshua Y., Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia
  • See, Emily, Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia
Background

Available estimates of the burden of acute kidney injury (AKI) in hospitalised children are inconsistent and the prognostic implications of its severity, duration, and frequency are poorly understood. Additionally, lack of hospital data on AKI impacts service provision and planning.

Methods

We used our electronic medical record to capture the epidemiology and outcome of AKI in a cohort of children aged between 1 month and 18 years who were hospitalised for at least 24 hours at a quaternary paediatric centre in Melbourne, Australia, between 1 January 2017 and 31 December 2021. AKI was examined according to phenotype in terms of KDIGO stage, duration (transient <48 h, persistent 48 h to 7 d, or acute kidney disease), and frequency. The primary outcome was 30-day mortality. Secondary outcomes included resource utilisation, hospital outcome, and major adverse kidney events at 30 days (MAKE30).

Results

A total of 4,214 AKI episodes occurred, involving 3,134 admissions for 1,540 children (incidence 16%; 17.77 episodes per 1000 patient-days). Most AKI was stage 1, transient, and occurred as a single episode. AKI was associated with an increased risk of 30-day mortality (aOR 3.93, 95% CI 2.77 to 5.58). Compared to children without AKI, children with AKI had a higher odds of ICU admission (aOR 3.40, 95% CI 3.13 to 3.69), mechanical ventilation (aOR 2.05, 95% CI 1.76 to 2.41), vasoactive drugs (aOR 3.76, 95% CI 3.28 to 4.30), and extracorporeal membrane oxygenation (aOR 32.37, 95% CI 15.73 to 66.60). Children with AKI were also more likely to die in hospital (aOR 5.98, 95% CI 4.29 to 8.35), be discharged to rehabilitation (aOR 2.03, 95% CI 1.66 to 2.47), or develop a MAKE30 (aOR 40.35, 95% CI 29.63 to 54.94) compared to children without AKI, when adjusted for ICU status and age. Most adverse events had a graded association with AKI stage and AKI duration; the association between AKI frequency and outcome is less clear.

Conclusion

AKI occurs commonly in hospitalised children and is associated with increased mortality and, among survivors, greater hospital resource utilisation. There was a graded increase in the magnitude of the association with increasing AKI severity and duration. This analysis could be automated and repeated over time to measure the impact of interventions to detect and reduce AKI.