• Poonam Mehta, Aditi Sinha, Abdus Sami, Pankaj Hari, Mani Kalaivani, Ashima Gulati, Madhulika Kabra, Sushil K Kabra, Rakesh Lodha, and Arvind Bagga.
• Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
• Indian Pediatr. 2012 Jul 1;49(7):537-42.

ObjectiveTo determine the incidence and outcome of acute kidney injury (AKI) in hospitalized patients.DesignProspective, observational.SettingTertiary care center in North India.Participants/PatientsInpatients, 1 month to 18 yrs.InterventionNone.Main Outcome MeasuresIncidence of AKI based on the serum creatinine criteria proposed by the AKI Network.ResultsDuring February to September 2008, thirty nine of 108 (36.1%) critically ill patients and 34 of 378 (9.0%) patients who were not critically ill developed AKI (P<0.001); the respective incidence densities were 45.1 and 11.7 cases/1000 patient days, respectively. The maximal stage of AKI was stage 1 in 48 (65.8%) patients, stage 2 in 13 (17.8%) and stage 3 in 12 (16.4%) patients; 11 (15.1%) required dialysis. Patients with AKI had a significantly longer duration of hospital stay (9 days vs 7 days, P<0.02) and higher mortality (37% vs 8.7%; hazard ratio, HR 2.73; 95% CI 1.64, 4.54). Independent risk factors for AKI were young age (HR 0.89; 95% CI 0.83, 0.95), shock (HR 2.65; 95% CI 1.32, 5.31), sepsis (HR 3.64; 95% CI 2.20, 6.01), and need for mechanical ventilation (2.18; 95% CI 1.12, 4.26). Compared to patients without AKI, the mortality was higher for AKI stage 2 (HR 5.18; 95% CI 2.59, 10.38) and stage 3 (HR 4.34; 95% CI 2.06, 9.16). Shock was an independent risk factor for mortality (HR 10.7; 95% CI 4.96, 22.98).ConclusionsAKI is common in critically ill children, especially younger patients with septicemia and shock, and results in increased hospital stay and high mortality.

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