Acute kidney injury (AKI) rates have increased over the past 2 decades among pediatric severe sepsis hospitalizations, investigators report, and the incidence is associated with an increased risk of death.

AKI increased from 9.4% of pediatric severe sepsis admissions in 2003 to 22.5% in 2019, Aravind Thavamani, MBBS, of UH Rainbow Babies and Children’s Hospital at Case Western Reserve University in Cleveland, Ohio, and colleagues reported in Pediatric Nephrology. Among 192,712 pediatric severe sepsis hospitalizations during the period, overall AKI prevalence was 23.6%. AKI was significantly more likely to develop in patients with diabetes mellitus, organ transplantation, HIV, urinary tract anomalies, and malnutrition.

The in-hospital mortality rate was significantly higher among pediatric sepsis hospitalizations involving AKI (19.8% vs 8.1%). Multivariate logistic regression analysis demonstrated that the odds of mortality increased 3.0- and 6.4-fold during admissions with AKI and AKI requiring kidney replacement therapy (KRT), respectively, compared with no AKI.

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Patients with severe sepsis and AKI had significantly longer median length of stay (14 vs 11 days) and higher total hospitalization charges ($168,106 vs 100,906) than those without AKI. Even without KRT, AKI was associated with 7.7 additional days of hospitalization and $154,536 more in hospitalization charges.

Dr Thavamani’s team suggested that the increased mortality after AKI requiring KRT reflects a sicker cohort with multiple organ failures putting them at increased risk for death.


Khatana J, Thavamani A, Umapathi KK, Sankararaman S, Roy A. Increasing incidence of acute kidney injury in pediatric severe sepsis and related adverse hospital outcomes. Pediatric Nephrology. Published online December 16, 2022. doi:10.1007/s00467-022-05866-x