Abstract
Ahmad K, Rajit B, Sean B, et al. N Engl J Med. Epub ahead of print 5 January 2017. DOI: 10.1056/NEJMoa1611391.
Acute kidney injury (AKI) in adults is associated with increased mortality. However, studies of AKI in children are sparse. Children usually do not have coexisting comorbidities, thus minimizing potential confounding. This multinational, prospective observational study assessed the association between AKI and 28-day mortality in children. AKI was defined using Kidney Disease: Improving Global Outcomes criteria, based on plasma creatinine and urine output.
The study included 4683 patients between the ages of 3 months to 25 years, admitted to the intensive care unit (ICU). Of these, 26.9% developed AKI, and 11.6% patients developed severe AKI. Death occurred in 11.0% of patients with severe AKI compared with 2.5% of patients without severe AKI. Accordingly, severe AKI significantly increased 28-day mortality (OR: 1.77; 95% CI: 1.17–2.68). Increases in AKI were also associated with increased use of renal replacement therapy, mechanical ventilation and longer stays in the PICU. Interestingly, independent use of plasma creatinine concentration alone to define AKI did not capture two-thirds of patients with low urine output.
This study highlights the importance of using both plasma creatinine concentration and urine output to define AKI in paediatric populations. The authors conclude that AKI is common in critically ill children and young adults, and associated with adverse outcomes.