Comparisons of definitions of acute kidney injury on admission to paediatric intensive care

Abstract

AIMS & OBJECTIVES: Robust comparisons of Acute Kidney Injury (AKI) prevalence and impact are hampered by the lack of consensus on the definition of AKI. The most commonly used AKI definitions are the Paediatric Risk, Injury, Failure, Loss of kidney function and End-stage renal disease (pRIFLE) and Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Recently, Renal Angina Index (RAI) and Paediatric Reference Change Value Optimized for AKI in Children (pROCK) have been proposed. We sought to explore i) the prevalence of AKI depending on criterion employed, and ii) the level of concordance between the different criteria. METHODS: This was a retrospective observational study in our multidisciplinary 36-bed tertiary Paediatric Intensive Care Unit (PICU). Children from birth to <16 years who were admitted from January 2015 to December 2018 were included. Criteria for each of the different AKI definitions (pROCK, pRIFLE, KDIGO) were calculated using data obtained from PICU admission until discharge. Day 1 RAI was calculated using components of score for the first 24 hours. RESULTS: Out of 7505 PICU admission episodes, the prevalence of AKI was 9.2% using KDIGO criteria. According to pROCK and pRIFLE criteria, the prevalences were 4.7% and 4.4% respectively. Nineteen-point two percent patients had a RAI≥8 on day 1. All patients who met pRIFLE criteria met KDIGO criteria too. Only 53 patients satisfied all four criteria (Figure 1). Mortality was 12.6% in the KDIGO AKI group. In patients who met both KDIGO and pRIFLE criteria, mortality increased to 26.6%. CONCLUSIONS: The prevalence of AKI varies considerably depending on the definitions employed.L6347729442021-04-21 <br />