MO1024: Exposures and Susceptibilities in Paediatric Acute Kidney Injury—Impact on Awareness and Survival
Authors: Chisavu Flavia , Gafencu Mihai , Chisavu Lazar , Stroescu Ramona , Mihaescu Adelina , Schiller Oana-Marina , Schiller Adalbert 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Acute kidney injury (AKI) is a growing global healthcare problem in the adult and paediatric population. In comparison with the adult population where the coexisting chronic conditions (e.g. diabetes, hypertension) increase the mortality risk during AKI, in children without chronic conditions one can assess the direct impact of AKI on mortality. Current paediatric studies state the need for increased awareness of AKI, for identifying susceptibilities and for the need to correct modifiable exposures in order to improve outcomes.

METHOD
We conducted a retrospective observational study in the ‘Louis Turcanu’ Emergency County Hospital for Children in Timisoara, Romania. Data were extracted from the hospital electronic database, between 1 January 2014 and 31 December 2020. The study cohort included 127 457 patients (aged 1 day–18 years) who had at least two serum creatinine levels determined during the same hospital admission. AKI was defined and staged according to Kidney Disease Improving Global Outcome (KDIGO) guidelines (and 2021 Consensus Conference) using Acute Kidney Injury Network (AKIN) criteria. Baseline serum creatinine was considered the nadir serum creatinine in 7 days from admission. AKI awareness in different medical clinics was considered the recognition of AKI diagnosis during admission as noted in the medical records according to ICD-10 Clinical Modification codes (N17.0, N17.1, N17.2, N17.8, N19, N99.0 and P96.0). AKI non-awareness was considered in patients presenting AKI according to AKIN without diagnoses recognition in the medical reports.

RESULTS
Over the 7-year study, 1867 patients developed AKI (out of 127 457 hospital admissions). The overall AKI incidence was 1.46%. The diagnosis of AKI was lacking (non-awareness) in 72.5% of AKI cases. We evaluated the exposures and susceptibilities of AKI patients and their impact on awareness and mortality. Taking into account the fact that the study addressed paediatric patients, exposures and susceptibilities have been changed accordingly. The considered exposures were: sepsis, critical illness, circulatory shock, burns, trauma, major non-cardiac surgery, nephrotoxic drugs, contact with poisonous plants and mechanical ventilation. Our regression equation proved to be a good fit for the model, explaining only 3.8% of AKI awareness (R2 = 0.038) and 22.9% of death events (R2 = 0.229). AKI awareness increases with the presence of dehydration (by 2.29-fold, P &lt; .05) and heart failure (by 2.54-fold, P &lt; .001). The risk of death increases with the presence of prematurity (by 2.33-fold, P &lt; .0001), cancer (by 2.45-fold, P &lt; .0001), anaemia (by 4.06-fold, P &lt; .0001) and chronic illness (by 2.65-fold, P &lt; .0001). The susceptibilities were: female gender, chronic kidney disease, chronic diseases (heart, lung, liver), diabetes mellitus, cancer, anaemia, very low birth weight, heart failure, arterial hypertension and stem cell transplant. Our regression equation proved to be a good fit for the model, explaining only 9.4% of AKI awareness (R2 = 0.094) and 43.6% of deaths (R2 = 0.436). The awareness increases with the presence of sepsis (by 1.73-fold, P &lt; .0001), of critical illness (by 2.41-fold, P &lt; .0001) and mechanical ventilation (by 1.54-fold, P &lt; .0001). The risk of death increases in the presence of sepsis (by 3.26-fold, P &lt; .0001), of critical illness (by 7.42-fold, P &lt; .0001), of mechanical ventilation (by 10.58-fold, P &lt; .0001) and hypovolemic shock (by 10.58-fold, P &lt; .0001).

CONCLUSION
The presence of more severe exposures and susceptibilities increased the awareness of AKI but also increased the risk of death. The diagnosis of AKI in our medical records is late, therefore late diagnosis has no benefits concerning the evolution and mortality of paediatric patients with AKI.