Acute Kidney Injury Epidemiology in pediatrics

Cleto-Yamane, Thais Lira; Gomes, Conrado Lysandro Rodrigues; Suassuna, Jose Hermogenes Rocco; Nogueira, Paulo Koch

doi:10.1590/2175-8239-JBN-2018-0127

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Brazilian Journal of Nephrology

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Review Article • J. Bras. Nefrol. 41 (2) • Apr-Jun 2019 • https://doi.org/10.1590/2175-8239-JBN-2018-0127 copy

Acute Kidney Injury Epidemiology in pediatrics

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

We performed a search in the MEDLINE database using the MeSH term: "Acute Kidney Injury", selecting the subtopic "Epidemiology", and applying age and year of publication filters. We also searched for the terms: "acute renal failure" and "epidemiology" "acute tubular necrosis" and "epidemiology" in the title and summary fields with the same filters. In a second search, we searched in the LILACS database, with the terms: "acute renal injury", or "acute renal failure" or "acute kidney injury" and the age filter. All abstracts were evaluated by the authors and the articles considered most relevant, were examined in their entirety. Acute Kidney Injury (AKI) -related mortality ranged from 3-63% in the studies included in this review. AKI etiology has marked regional differences, with sepsis being the main cause in developed countries. In developing countries, primary renal diseases and hypovolemia are still a common cause of AKI.

Keywords:
Renal Failure; Acute Kidney Injury; Epidemiology

Classification	Year	Stage	Creatinine	Urinary output
RIFLE²2 Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Quality Initiative workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:R204-12.	2004	R I F L E	Increase ≥ 1.5x or GFR reduction ≥ 25% Increase ≥ 2x or GFR reduction ≥ 50% Increase ≥ 3 x or creatinine ≥ 4 mg/dL Persistent failure or > 4 weeks Persistent failure for > 3 months	< 0.5mL/kg/h per 6 h < 0.5mL/kg/h per 12 h < 0.3mL/kg/h per 24 h or anuria for 12 h
p-RIFLE¹⁰10 Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 2007;71:1028-35.	2007	R I F L E	Reduction in the estimated CrCl ≥ 25% Reduction in the estimated CrCl ≥ 50% Reduction in the estimated CrCl ≥ 50% Reduction in the estimated CrCl ≥ 75% or estimated CrCl < 35mL/min/1.73m²Persistent failure for > 4 weeks Persistent failure for > 3 months	< 0.5mL/kg/h for 8 h < 0.5mL/kg/h for 16 h < 0.3mL/kg/h for 24 h or anuria for 12 h
AKIN²²22 Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al.; Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31.	2007	1 2 3	Increase ≥ 0,3 mg/dL or increase to 150-200% of baseline Increase to 200-300% of baseline Increase to ≥ 300% of baseline or Cr ≥ 4 mg/dL with sharp increase of 0.5 mg/dL	< 0.5mL/kg/h for 6 h < 0.5mL/kg/h for 12 h < 0.3mL/kg/h for 24 h or anuria for 12 h
KDIGO¹¹11 John A. Kellum, Norbert Lameire, Peter Aspelin, Rashad S. Barsoum, Emmanuel A. Burdmann, Stuart L. Goldstein et al. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl 2012;2:1-138.	2012	1 2 3	Increase of 0.3 mg/dL (in 48 h) or 150-200% (in 7 days) Increase ≥ 200-300% Increase ≥ 300%, Cr ≥ 4 mg/dL or dialysis or eGFR < 35mL/min/1.73 m² for < 18 years	< 0.5mL/kg/h for 8 h < 0.5mL/kg/h for 16 h < 0.3mL/kg/h for 24 h or anuria for 12 h
KDIGO neonatal²³23 Jetton JG, Askenazi DJ. Update on acute kidney injury in the neonate. Curr Opin Pediatr 2012;24:191-6.	2015	0 1 2 3	No increase or increase < 0.3 mg/dL Increase ≥ 0.3 mg/dL in 48 h or increase ≥ 1.5-1.9x reference value in 7 days Increase ≥ 2.0-2.9x reference value Increase ≥ 3x reference value or Cr ≥ 2.5 mg/dL or dialysis	≥ 0.5mg/kg/h < 0.5mg/dL for 6-12 h < 0.5mg/dL for ≥ 12 h < 0.3mg/dL for ≥ 24 h or anuria for ≥ 12 h

Country	Year	Study design	AKI diagnostic criteria	Patient characteristics	Number of patients	% RRT*	Incidence (%)	Mortality (%)
Nigeria⁵⁴54 Olowu WA, Adelusola KA. Pediatric acute renal failure in southwestern Nigeria. Kidney Int 2004;66:1541-8.	2004	Prospective Single center	Non-standardized definition	0-15 year-old patients admitted with AKI diagnosis	123	53	---	43.9
Thailand¹⁹19 Vachvanichsanong P, Dissaneewate P, Lim A, McNeil E. Childhood acute renal failure: 22-year experience in a university hospital in southern Thailand. Pediatrics 2006;118:e786-91.	2006	RetrospectiveSingle center	Non-standardized definition	1 month-17 years patients with AKI diagnosis in Thai hospital	311	17.6	---	41.5 63.6 if RRT
New Zeland¹⁶16 Ball EF, Kara T. Epidemiology and outcome of acute kidney injury in New Zealand children. J Paediatr Child Health 2008;44:642-6.	2008	Retrospective Single center	Only patients who required RRT	0-15year-old AKI patients submitted to RRT	226	100	---	11
United States⁵5 Schneider J, Khemani R, Grushkin C, Bart R. Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med 2010;38:933-9.	2010	Retrospective Single center	RIFLE	31 days-21 years patients admitted to the PICU	3.396	1.2	10	30-32 42.5 if RRT
United States²⁷27 Sutherland SM, Ji J, Sheikhi FH, Widen E, Tian L, Alexander SR, et al. AKI in hospitalized children: epidemiology and clinical associations in a national cohort. Clin J Am Soc Nephrol 2013;8:1661-9.	2013	RetrospectiveMulticentric	Patients diagnosed with AKI by the ICD **	0-18 year-old patients admitted to 4121 hospitals of the country in 2009	2.644.263	8.8	0.39	15.3
China¹⁸18 Cao Y, Yi ZW, Zhang H, Dang XQ, Wu XC, Huang AW. Etiology and outcomes of acute kidney injury in Chinese children: a prospective multicentre investigation. BMC Urol 2013;13:41.	2013	ProspectiveMulticentric	AKIN	15 days to 18 year-old patients admitted to 27 hospitals in 2008	388.736	15.1	0.32	3.4
United States³⁰30 Carmody JB, Swanson JR, Rhone ET, Charlton JR. Recognition and reporting of AKI in very low birth weight infants. Clin J Am Soc Nephrol 2014;9:2036-43.	2014	RetrospectiveSingle center	KDIGO	Newborns with weight ≤ 1500 g admitted to NNICU from 2008-2011	455	0.55	39.8	14.4
United States²⁸28 Sanchez-Pinto LN, Goldstein SL, Schneider JB, Khemani RG. Association Between Progression and Improvement of Acute Kidney Injury and Mortality in Critically Ill Children. Pediatr Crit Care Med 2015;16:703-10.	2015	Retrospective Single center	KDIGO	1 month-21 year-old patients admitted to the PICU 2003-2012	8260	17.7	11.8	25.3
United States²⁹29 Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL; AWARE Investigators. Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults. N Engl J Med 2017;376:11-20.	2017	Prospective Multicentric	KDIGO	3 months-25 year old patients admitted to 32 PICUs in 4 continents	4984	1.5	26.9	5.5 11 if stage 2 or 3
Pakistan³¹31 Tresa V, Yaseen A, Lanewala AA, Hashmi S, Khatri S, Ali I, et al. Etiology, clinical profile and short-term outcome of acute kidney injury in children at a tertiary care pediatric nephrology center in Pakistan. Ren Fail 2017;39:26-31.	2017	Prospective Single center	pRIFLE	1 month-15 year-old patients with AKI diagnosis admitted in 1 year	116	53	---	5.3
India³²32 Rustagi RS, Arora K, Das RR, Pooni PA, Singh D. Incidence, risk factors and outcome of acute kidney injury in critically ill children - a developing country perspective. Paediatr Int Child Health 2017;37:35-41.	2017	Prospective Single center	pRIFLE	2 months-18 year old patients admitted to the PICU in 1 year	380	19	14	36

Year	Study design	AKI diagnostic criterion	Patient characteristics	Number of patients	% RRT	Incidence	Mortality
2008³³33 Tavares MS. Análise de mortalidade em crianças com insuficiência renal aguda submetidas à diálise peritoneal. J Bras Nefrol 2008;30:180-4.	RetrospectiveSingle center	Patients submitted to peritoneal dialysis	0-12 year-old patients admitted to the PICU or NNICU who required PD between 2002 and 2006	45	100	---	53.3
2009³⁴34 Bresolin N, Silva C, Halllal A, Toporovski J, Fernandes V, Góes J, et al. Prognosis for children with acute kidney injury in the intensive care unit. Pediatr Nephrol 2009;24:537-44.	Prospective Single center	Creatinine higher than the reference value for age/height	0-15 year-old patients with AKI admitted to the PICU between 2002-2004	110	49.1	8	33.6
2013³⁵35 Bresolin N, Bianchini AP, Haas CA. Pediatric acute kidney injury assessed by pRIFLE as a prognostic factor in the intensive care unit. Pediatr Nephrol 2013;28:485-92.	Prospective Single center	pRIFLE	28 days-15 year-old patients admitted to the PICU during 3 months	126	12	46	36.2
2015³⁶36 Cabral FC, Ramos Garcia PC, Mattiello R, Dresser D, Fiori HH, Korb C, et al. Influence of Acute Kidney Injury Defined by the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease Score on the Clinical Course of PICU Patients. Pediatr Crit Care Med 2015;16:e275-82.	Retrospective Single center	pRIFLE	29 days-18 year-old patients admitted to the PICU in 1 year	375	---	54,9	16
2016³⁸38 Volpon LC, Sugo EK, Consulin JC, Tavares TL, Aragon DC, Carlotti A. Epidemiology and Outcome of Acute Kidney Injury According to Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease and Kidney Disease: Improving Global Outcomes Criteria in Critically Ill Children-A Prospective Study. Pediatric Crit Care Med 2016;17:e229-38.	Prospective Single center	pRIFLE/KDIGO	0-20 years admitted to the PICU in 6 months	160	----	51,3% (pRIFLE) 42% (KDIGO)	11,4% (pRIFLE) 12,2% (KDIGO)
2017³⁷37 Riyuzo MC, Silveira LV, Macedo CS, Fioretto JR. Predictive factors of mortality in pediatric patients with acute renal injury associated with sepsis. J Pediatr (Rio J) 2017;93:28-34.	Retrospective Single center	pRIFLE	1 month-11-year old patients admitted to the PICU in 4 years with a diagnosis of sepsis and AKI	77	42.8	---	33.7

Year	Study place	Patient characteristics	Main AKI etiologies
2005⁴⁰40 Hui-Stickle S, Brewer ED, Goldstein SL. Pediatric ARF epidemiology at a tertiary care center from 1999 to 2001. Am J Kidney Dis 2005;45:96-101.	United States	0-21 year-old patients diagnosed with AKI.	Ischemia, nephrotoxicity and sepsis
2006¹⁹19 Vachvanichsanong P, Dissaneewate P, Lim A, McNeil E. Childhood acute renal failure: 22-year experience in a university hospital in southern Thailand. Pediatrics 2006;118:e786-91.	Thailand	0-17 year-old patients diagnosed with AKI	sepsis, hypovolemia and ADG
2007¹⁰10 Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 2007;71:1028-35.	United States	0-21 year-old patients with AKI.	pneumonia, sepsis and shock
2007⁴4 Symons JM, Chua AN, Somers MJ, Baum MA, Bunchman TE, Benfield MR, et al. Demographic characteristics of pediatric continuous renal replacement therapy: a report of the prospective pediatric continuous renal replacement therapy registry. Clin J Am Soc Nephrol 2007;2:732-8.	United States	0-25 year-old patients who received Continuous Renal Replacement	sepsis, bone marrow transplant and heart diseases
2008¹⁶16 Ball EF, Kara T. Epidemiology and outcome of acute kidney injury in New Zealand children. J Paediatr Child Health 2008;44:642-6.	New Zealand	0-15 year-old patients who received Renal Replacement Therapy	Heart surgery, hemolytic-uremic syndrome and sepsis
2010⁴²42 Santiago MJ, Lopez-Herce J, Urbano J, Solana MJ, del Castillo J, Ballestero Y, et al. Clinical course and mortality risk factors in critically ill children requiring continuous renal replacement therapy. Intensive Care Med 2010;36:843-9.	Spain	Patients with a mean age of 52 months who received Continuous Renal Replacement Therapy	Heart diseases, sepsis, and renal failure flaring.
2013²⁷27 Sutherland SM, Ji J, Sheikhi FH, Widen E, Tian L, Alexander SR, et al. AKI in hospitalized children: epidemiology and clinical associations in a national cohort. Clin J Am Soc Nephrol 2013;8:1661-9.	United States	0-18 year-old patients admitted to 4,121 hospitals	shock, sepsis and liver diseases
2013¹⁸18 Cao Y, Yi ZW, Zhang H, Dang XQ, Wu XC, Huang AW. Etiology and outcomes of acute kidney injury in Chinese children: a prospective multicentre investigation. BMC Urol 2013;13:41.	China	0-17 year-old patients admitted to 27 hospitals	Acute glomerulonephritis, severe dehydration and nephrotic syndrome
2016³²32 Rustagi RS, Arora K, Das RR, Pooni PA, Singh D. Incidence, risk factors and outcome of acute kidney injury in critically ill children - a developing country perspective. Paediatr Int Child Health 2017;37:35-41.	India	0-18 year-old patients admitted to the PICU in 1 hospital	Shock, sepsis and respiratory failure
2016³¹31 Tresa V, Yaseen A, Lanewala AA, Hashmi S, Khatri S, Ali I, et al. Etiology, clinical profile and short-term outcome of acute kidney injury in children at a tertiary care pediatric nephrology center in Pakistan. Ren Fail 2017;39:26-31.	Pakistan	0-15 year-old patients admitted in 1 hospital	Post-infectious glomerulonephritis, urolithiasis and crescent GN

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[1] Correspondence to: Thais Lira Cleto-Yamane. E-mail: thaiscleto@yahoo.com.br