Acute kidney injury in childhood cancer: An insight from Kids' Inpatient Database.

Abstract

e18379 Background: Oncology patients are at high risk for Acute Kidney Injury (AKI). AKI may occur due to direct injury from primary cancer, nephrotoxic effects of chemotherapy, hematopoietic stem-cell transplantation or following comorbidities like sepsis and metabolic disturbance. AKI is associated with prolonged hospital stay, high healthcare cost and increased mortality in critically ill patients. Despite the increased risk and these associations, the national rate and clinical outcome of AKI among pediatric oncology patients is not well described. Objective: Define AKI incidence and health outcomes among pediatric oncology patients in the United States (U.S.). Methods: We performed a retrospective cohort analysis of the Health Cost and Utilization Project (HCUP) Kids’ Inpatient 2000-2012 Database (KID) for patient ≤ 20 years of age. Patients with principal diagnosis of acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), lymphomas (Hodgkin and non-Hodgkin), brain tumor, neuroblastoma, bone tumors (Ewing’s Sarcoma and Osteosarcoma) and hepatoblastoma were reviewed. Encounters for chemotherapy were excluded. Patients with medical diagnosis of AKI were identified using ICD-9-CM codes. We performed descriptive statistics to characterize the cohort in terms of demographic factors (age, race, sex, insurance type), hospital characteristics and comorbidities. Data weights were applied to sampled patients to provide national estimates. The in-hospital mortality rate, total charges, and hospital length of stay (LOS) were compared between cancer patients with and without AKI using bivariable analyses. Results: A total of 266,113 admissions were included for analysis. The cohort was comprised of 4,761 patients with AKI, with an overall incidence 18 per 1,000 admissions. The median age was 13 years. Males (58.45%), and whites (55.4%) were more commonly affected. South and west regions (59%) of the U.S. had higher frequency of AKI. AML was the most common diagnosis associated with AKI (4.1%). Patients with AKI had significantly higher mortality rates (21.78% vs. 1.36%, p < 0.0001), longer median LOS (15 days vs. 4 days, p < 0.0001) and higher median total charges per hospitalization ($132,712 vs $18,856) when compared to patients without AKI. Conclusions: AKI in pediatric oncology patients is significantly associated with increased in-hospital mortality, LOS, and higher healthcare cost in pediatric oncology patients. This area needs focused research and quality improvement initiatives.