Epidemiology and outcomes of community-acquired and hospital-acquired acute kidney injury in children and adolescents

BackgroundHospital-acquired acute kidney injury (HA-AKI) is associated with an increased risk of childhood mortality; however, only a few studies have addressed community-acquired AKI (CA-AKI).MethodsAKI network classification was used to assess CA- and HA-AKI, 2010-2014. Patients with CA-AKI who were admitted to an inpatient setting were categorized as CAA-AKI. CANA-AKI was for CA-AKI not admitted to inpatient care. Epidemiology, factors associated with AKI, and in-hospital outcomes were assessed for variation.ResultsPrevalence of CANA-AKI was 4/1,000 outpatient visits, 17/1,000 hospital admissions for CAA-AKI, and 9.69/1,000 hospital admissions for HA-AKI. Mortality was higher among AKI patients (HA-AKI, 13.64%; CAA-AKI, 3.7%) than in no-AKI patients (0.57%). Patients with AKI and those with severe stages of AKI resulted in an increase in health-care service utilization (both P<0.001). Prior renal disease and recent hospitalization were associated with pediatric AKI in both outpatient and inpatient settings. Hematological malignancies, congenital anomalies, circulatory disease, and nephrotoxic medication use were associated with AKI, although the extent of associations varied slightly by setting.ConclusionIncreasing incidence of AKI in the community emphasizes the need for an increased awareness of AKI among health professionals to identify at-risk children and monitor SCr, so that modifiable risk factors can be managed.