Among children who experience acute kidney injury (AKI) during hospitalization, mortality is highest among neonates and those requiring critical care or dialysis, according to researchers.

Scott M. Sutherland, MD, of Stanford University in Stanford, Calif., and colleagues analyzed data from 2.6 million children in the 2009 Kids Inpatient Database. AKI developed in 10,322 subjects, for an incidence of 3.9 per 1,000 admissions, Dr. Sutherland’s group reported in the Clinical Journal of the American Society of Nephrology.

“This study represents the most extensive epidemiologic description of AKI among hospitalized children in the United States,” the authors wrote.  

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The highest incidence was observed in children aged 15-18 years (6.6 per 1,000 admissions).

Although 49% of the cohort was white, AKI incidence was higher among African Americans (4.5 vs. 3.8 per 1,000 admissions). In-hospital mortality among children with AKI was 15.3%, but it was higher among those one month older or younger (31.3% vs. 10.1) and children requiring admission to an intensive care unit (ICU) or dialysis (32.8% vs. 9.4% and 27.1% vs. 14.2%, respectively).

“Our study also shows the heightened case complexity and health risks associated with AKI,” the researchers observed. “Hospitalizations complicated by AKI had significantly more diagnoses, chronic conditions, and procedures documented at discharge.”

Among children older than one month, AKI was associated with liver disease, respiratory failure, and pulmonary collapse/pulmonary inflammation, shock, septicemia, and coagulation disorders. In addition, data showed that AKI was associated with such procedures as intubation and mechanical ventilation, vascular catheterization, and blood transfusions.

Among children aged one month or younger, investigators observed a similar pattern of associations between AKI and diagnoses, but AKI also was associated with circulatory diseases, congenital cardiac disease, and postoperative complications. With respect to procedures, AKI was associated with extracorporeal membrane oxygenation and intraoperative bypass and operating room vascular procedures.