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Clin J Am Soc Nephrol. 2018 Dec 7;13(12):1791-1800. doi: 10.2215/CJN.00800118. Epub 2018 Oct 4.

Acute Kidney Injury among Hospitalized Children in China.

Xu X1, Nie S1, Zhang A2, Mao J3, Liu HP4, Xia H5, Xu H6, Liu Z7, Feng S8, Zhou W9, Liu X10, Yang Y11, Tao Y12, Feng Y13, Chen C14, Wang M15, Zha Y16, Feng JH17, Li Q18, Ge S19, Chen J20, He Y21, Teng S22, Hao C23, Liu BC24, Tang Y25, He W1, He P1, Hou FF26.

Author information

1
National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China.
2
Department of Nephrology, Children's Hospital of Nanjing Medical University, Nanjing, China.
3
Department of Nephrology, The Children's Hospital of Zhejiang University, Hangzhou, China.
4
Anhui Institute of Pediatric Research, Anhui Provincial Children's Hospital, Hefei, China.
5
Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
6
Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China.
7
Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
8
Department of Nephrology, Chengdu Women and Children's Central Hospital, Chengdu, China.
9
Shanghai Children's Medical Center, Shanghai Jiaotong University, Shanghai, China.
10
Department of Nephrology, Jinan Children's Hospital, Jinan, China.
11
Pediatric Medical Research Center, Gansu Province Child's Hospital, Lanzhou University Second Hospital, Lanzhou, China.
12
West China Second University Hospital, Sichuan University, Chengdu, China.
13
Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
14
Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
15
Department of Nephrology, Children's Hospital of Chongqing Medical University, Chongqing, China.
16
Guizhou Provincial People's Hospital, Guizhou University, Guiyang, China.
17
Department of Pediatrics, The Second Affiliated Hospital and.
18
Department of Nephrology, Guilin Medical University Affiliated Hospital, Guilin, China.
19
Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
20
Kidney Disease Center, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.
21
Center for Nephrology and Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen, China.
22
Department of Nephrology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China.
23
Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China.
24
Institute of Nephrology, Zhong Da Hospital, Nanjing, China; and.
25
Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
26
National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China; ffhouguangzhou@163.com.

Abstract

BACKGROUND AND OBJECTIVES:

High-quality epidemiologic data on AKI in children are particularly lacking in developing countries. This study aimed to assess the epidemiology and clinical correlates of AKI among hospitalized children in China.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

We performed a multicenter study, in a cohort of hospitalized children aged 1 month to 18 years, from 25 general and children's hospitals in China during 2013-2015. We obtained patient-level data from the electronic hospitalization information system and laboratory databases of all children who had at least two serum creatinine tests within any 7-day window during their first 30 days of hospitalization. We identified AKI events according to the creatinine criteria of Kidney Disease Improving Global Outcomes. The in-hospital outcomes of AKI, including mortality, kidney recovery, and length of stay, were assessed. We estimated the corresponding hazard ratios using a Cox proportional hazard model, with adjustment for age, sex, comorbidities, and clinical procedures.

RESULTS:

A total of 19,908 (20%) patients with AKI were identified among 101,836 pediatric inpatients, of which 7220 (7%) were community acquired and 12,688 (13%) were hospital acquired. Up to 96% of these AKI events were not diagnosed on the discharge records. The cumulative incidence of AKI in infants (28%) was twice that in adolescents (12%). The profiles of risk factors differed between community-acquired and hospital-acquired AKI and varied with age. Diarrhea and sepsis were the top risk factors for community-acquired AKI, each contributing 6% of the risk. Congenital heart disease/cardiac surgery was the major risk factor for hospital-acquired AKI, contributing to 19% of cases. Exposure to nephrotoxic drugs, mostly nonsteroidal anti-inflammatory drugs and proton pump inhibitors, was common in hospitalized children and was associated with a higher risk of AKI. Death occurred in 842 out of 19,908 patients (4%) with AKI versus 450 out of 81,478 children (0.5%) without AKI. The risk of in-hospital death was higher among children with severe AKI, shock, and respiratory failure. Pediatric AKI was associated with longer hospital stay and higher daily cost, even after adjustment for covariates.

CONCLUSIONS:

Pediatric AKI is common and is substantially underdiagnosed in China.

KEYWORDS:

acute renal failure; children; clinical epidemiology

PMID:
30287424
PMCID:
PMC6302328
[Available on 2019-12-07]
DOI:
10.2215/CJN.00800118

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