Pediatric acute kidney injury in North India: A prospective hospital-based study

Abstract

The conducted study aimed to determine the incidence and clinical profile of acute kidney injury (AKI) in hospitalized patients using the AKI Network (AKIN) criteria. This prospective observational study was conducted at the Pediatric ward and pediatric Intensive Care Unit of a tertiary level teaching hospital in North India. The participants were 763 consecutive patients aged three months to 12 years from January 2014 to October 2015 and were assessed for eligibility. Of these, 163 patients were excluded from the study. Main outcome measure was incidence of AKI based on the AKIN criteria. Factors associated with AKI were analyzed. A total of 600 patients (141 critically ill and 459 noncritically ill) were enrolled. The incidence of AKI was 25.2% (n = 151); it was significantly higher among critically ill (53.2%) than non-critically ill patients (16.6%), P <0.001. Most patients with AKI were in Stage 1 (n = 99; 65.6%). Ten patients (6.6%) required dialysis (peritoneal dialysis n = 8; hemodialysis n = 2). Patient with AKI had significantly higher median (interquartile range) PIM-2 score, 22.6 (5–61.7), longer hospital stay (10 vs. 7 days), and mortality rate (28.5% vs. 3.6%); P <0.001. Nephrotoxic drugs [hazard ratio (HR): 5.5, 95% confidence interval (CI): 2.6–11.4; P = 0.001]; hypovolemia (HR: 1.7, 95% CI: 1–2.7; P = 0.035); sepsis (HR 2.3, 95% CI: 1.1–5); and mechanical ventilation (HR: 3.3, 95% CI: 1.6–6.8) were independent predictors for AKI. AKI was an independent risk factor for mortality and risk increased with increasing stage of AKI. Mortality was significantly higher in Stage 3 AKI (n = 14; 60.9%); P <0.001. Independent predictors for mortality in AKI were acidosis (HR: 3.6; 95% CI 1.5–8.6), mechanical ventilation (HR: 34; 95% CI 9.3-123), shock (HR: 19.7; 95% CI 2–194), and sepsis (HR: 3; 95% CI 1-8). The incidence of AKI is high among pediatric patients admitted to this center, including among noncritically ill children. AKI is associated with significantly increased morbidity and mortality.