Abstract
Objective: Acute kidney injury (AKI) is a significant cause of morbidity and mortality among hospitalised patients. The objectives in this study were (i) to investigate the incidence of AKI using the National Health Services (NHS) AKI e-alert algorithm as a means of identifying AKI; and (ii) in a randomly selected sub-group of children with AKI identified using the algorithm, to evaluate the recognition and management of AKI.Patients and Methods: Retrospective cross-sectional study with initial electronic retrieval of creatinine measurements at six hospitals in England over a six-month period. Results were evaluated using the NHS AKI e-alert algorithm with recognition and management of AKI stages 1, 2 and 3 reviewed in a sub-set of randomly selected patient case notes. Patients aged 29 to 17 years were included. AKI stage 1 was defined as a rise of 1.5 – ≤2x baseline creatinine level; AKI stage 2 a rise of ≤ 2.0 and < 3.0; AKI stage 3 a rise of ≥ 3.0. Urine output was not considered for AKI staging.Results: 57,278 creatinine measurements were analysed. 5,325 (10.8%) AKI alerts were noted in 1,112 patients with AKI 1 (62%), AKI 2 (16%) and AKI 3 (22%). There were 222 (20%) <1y, 432 (39%) 1 ≤ 6y, 192 (17%) 6 ≤ 11y, 207 (19%) 11 ≤ 16y, and 59 (5%) 16–17y. Case notes of 123 of 1,112 [11.1%] children with AKI alerts were reviewed. Confirmed AKI was recognised with a documented management plan following its identification in n = 32 [26%] patients only.Conclusions: In this first multicentre study of the incidence of AKI in children admitted to selected hospitals across England, the incidence of AKI was 10.8% with most patients under the age of 6 years and with AKI stage 1. Recognition and management of AKI was seen in just over 25% children. These data highlight the need to improve recognition of AKI in hospitalised children in the UK.
Highlights
METHODSAcute kidney injury (AKI) is characterised by a reversible loss of normal kidney function and is recognised by a reduction in urine output and/or an increase in serum creatinine, indicative of a reduction in glomerular filtration rate (GFR)
AKI stage 1 was the largest group across all ages and 59% of all AKI alerts occurred in those aged
Most of the paediatric studies are either single centre or, if multicentre, focused on high risk groups such as children in PICU whereas this study looked at the incidence of AKI among all hospitalised patients
Summary
Acute kidney injury (AKI) is characterised by a reversible loss of normal kidney function and is recognised by a reduction in urine output and/or an increase in serum creatinine, indicative of a reduction in glomerular filtration rate (GFR) It is usually accompanied by an inability of the kidneys to maintain water, acid-base and electrolyte balance [1, 2]. The definition of AKI has undergone several iterations [3] and to define and stratify the severity of AKI several classification systems have been proposed and include the RIFLE, AKIN, and KDIGO criteria [4] These consensus definitions are to be welcomed as they help to standardise the diagnosis of AKI, stratify AKI severity and allow the development of predictors of outcomes based on the AKI staging. Similar data have been reported from other parts of the world [11, 12]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
