#6039 EPIDEMIOLOGY AND OUTCOMES OF ACUTE KIDNEY INJURY: DON'T FORGET THE CHILDREN

Abstract

Abstract Background and Aims Acute kidney disease (AKI) has evolved from a primary single renal disease to a syndrome secondary to other systemic illness. The aim of this study is to asses AKI epidemiology in a large East European country database comprising a mixt paediatric population (critically ill and non-critically ill) and the impact on mortality and hospitalization length. Method We conducted a retrospective observational study on all the admitted paediatric patients from 1 day to 18 years old between first of January 2014 until 31 December 2021. Out of 137760 admissions, 2194 patients were included in the study. We classified the different age groups as: premature (all the babies born before 37 weeks of gestation), full-term new-borns, infants (between 28 days and 12 months of life), toddlers (over 12 months up to 3 years), pre-schoolers (between 3 and 5 years), scholars (6 years to 11 years) and adolescents (12 to 18 years). Results The overall incidence of AKI was 15.92/1000 hospital admissions with a 4.77 times fold increased incidence over the 8 year period, from 6.72 in 2014 to 32.12/1000 admissions in 2021. The most prevalent age group, accounting for almost half the AKI cohort (49.49%), was represented by the neonatal setting with 527 (24.02%) preterm and 559 (25.47%) full-term neonates. The paediatric age groups were represented by 10.84% infants, 8.29% toddlers, 6.65% pre-schoolers, 10.57% school aged children and 14.17% adolescents. Staging AKI according to AKIN, stage 1 was identified by us in 24.24% of the AKI cases, stage 2 in 31.03% and stage 3 in 44.71%. Only 25 patients (1.1%) required RRT. Dividing the cases by AKI causes, the most common was represented by prerenal AKI in 85.64% of the cases, followed by 12.16% renal causes respectively 2.18% postrenal causes. Over the 8-years period, from the 137 760 admitted children, 0.32% (449 patients) died of whom 255 (56.79%) presented AKI diagnosis. The risk of death in the presence of AKI was 109 times higher than in the no-AKI group (p<0.0001, 95% CI: 90-132), mortality in the AKI group being 11.62%. Stage 3 AKI group had a higher risk of death than stage 1 with an OR of 3.31 (CI = 2.516-4.355, p<0.001). The average hospitalization period for all admitted patients (137 760) was 5.76 days. In the presence of AKI the average hospitalization period increased to 20.9 days ± 19.3 days. Conclusion The neonatal setting portends poor outcomes with the highest incidence of AKI. We can state that in the 21st century patients do no die of AKI but with AKI. Hospitalization increased significantly in the presence of AKI.