Healthcare Utilization after Acute Kidney Injury in the Pediatric Intensive Care Unit.
BACKGROUND AND OBJECTIVES
Little is known about the long-term burden of AKI in the pediatric intensive care unit. We aim to evaluate if pediatric AKI is associated with higher health service use post-hospital discharge.


DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
This is a retrospective cohort study of children (≤18 years old) admitted to two tertiary centers in Montreal, Canada. Only the first admission per patient was included. AKI was defined in two ways: serum creatinine alone or serum creatinine and/or urine output. The outcomes were 30-day, 1-year, and 5-year hospitalizations, emergency room visits, and physician visits per person-time using provincial administrative data. Univariable and multivariable Poisson regression were used to evaluate AKI associations with outcomes.


RESULTS
A total of 2041 children were included (56% male, mean admission age 6.5±5.8 years); 299 of 1575 (19%) developed AKI defined using serum creatinine alone, and when urine output was included in the AKI definition 355 of 1622 (22%) children developed AKI. AKI defined using serum creatinine alone and AKI defined using serum creatinine and urine output were both associated with higher 1- and 5-year hospitalization risk (AKI by serum creatinine alone adjusted relative risk, 1.42; 95% confidence interval, 1.12 to 1.82; and 1.80; 1.54 to 2.11, respectively [similar when urine output was included]) and higher 5-year physician visits (adjusted relative risk, 1.26; 95% confidence interval, 1.14 to 1.39). AKI was not associated with emergency room use after adjustments.


CONCLUSIONS
AKI is independently associated with higher hospitalizations and physician visits postdischarge.
['Hessey|Erin|E|', 'Morissette|Geneviève|G|', 'Lacroix|Jacques|J|', 'Perreault|Sylvie|S|', 'Samuel|Susan|S|', 'Dorais|Marc|M|', 'Phan|Véronique|V|', 'Jouvet|Philippe|P|', 'Lafrance|Jean-Philippe|JP|0000-0001-7876-0446', 'LeLorier|Jacques|J|', 'Palijan|Ana|A|', 'Pizzi|Michael|M|', 'Roy|Louise|L|', 'Zappitelli|Michael|M|']
D058186:Acute Kidney Injury D002648:Child D002675:Child, Preschool D003404:Creatinine D004636:Emergency Service, Hospital D005260:Female D006760:Hospitalization D006801:Humans D007223:Infant D015278:Intensive Care Units, Pediatric D008297:Male D010342:Patient Acceptance of Health Care D012189:Retrospective Studies
Acute Kidney Injury pediatrics children creatinine hospitalization Risk Confidence Intervals Emergency Service, Hospital Epidemiology and outcomes Intensive Care Units, Pediatric Patient Discharge Retrospective Studies acute renal failure clinical epidemiology pediatric nephrology