AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions.
BACKGROUND AND OBJECTIVES
Although several standardized definitions for AKI have been developed, no consensus exists regarding which to use in children. This study applied the Pediatric RIFLE (pRIFLE), AKI Network (AKIN), and Kidney Disease Improving Global Outcomes (KDIGO) criteria to an anonymized cohort of hospitalizations extracted from the electronic medical record to compare AKI incidence and outcomes in intensive care unit (ICU) and non-ICU pediatric populations.


DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
Observational, electronic medical record-enabled study of 14,795 hospitalizations at the Lucile Packard Children's Hospital between 2006 and 2010. AKI and AKI severity stage were defined by the pRIFLE, AKIN, and KDIGO definitions according to creatinine change criteria; urine output criteria were not used. The incidences of AKI and each AKI stage were calculated for each classification system. All-cause, in-hospital mortality and total hospital length of stay (LOS) were compared at each subsequent AKI stage by Fisher exact and Kolmogorov-Smirnov tests, respectively.


RESULTS
AKI incidences across the cohort according to pRIFLE, AKIN, and KDIGO were 51.1%, 37.3%, and 40.3%. Mortality was higher among patients with AKI across all definitions (pRIFLE, 2.3%; AKIN, 2.7%; KDIGO, 2.5%; P<0.001 versus no AKI [0.8%-1.0%]). Within the ICU, pRIFLE, AKIN, and KDIGO demonstrated progressively higher mortality at each AKI severity stage; AKI was not associated with mortality outside the ICU by any definition. Both in and outside the ICU, AKI was associated with significantly higher LOS at each AKI severity stage across all three definitions (P<0.001). Definitions resulted in differences in diagnosis and staging of AKI; staging agreement ranged from 76.7% to 92.5%.


CONCLUSIONS
Application of the three definitions led to differences in AKI incidence and staging. AKI was associated with greater mortality and LOS in the ICU and greater LOS outside the ICU. All three definitions demonstrated excellent interstage discrimination. While each definition offers advantages, these results underscore the need to adopt a single, universal AKI definition.
['Sutherland|Scott M|SM|', 'Byrnes|John J|JJ|', 'Kothari|Manish|M|', 'Longhurst|Christopher A|CA|', 'Dutta|Sanjeev|S|', 'Garcia|Pablo|P|', 'Goldstein|Stuart L|SL|']
D058186:Acute Kidney Injury D000293:Adolescent D000367:Age Factors D015415:Biomarkers D002140:California D002648:Child D002675:Child, Preschool D032921:Consensus D003404:Creatinine D057286:Electronic Health Records D005260:Female D005919:Glomerular Filtration Rate D006305:Health Status Indicators D017052:Hospital Mortality D006760:Hospitalization D006801:Humans D015994:Incidence D007223:Infant D015278:Intensive Care Units, Pediatric D007668:Kidney D007902:Length of Stay D008297:Male D011237:Predictive Value of Tests D012189:Retrospective Studies D012307:Risk Factors D012720:Severity of Illness Index D013997:Time Factors
children mortality acute renal failure kidney failure