A Cross-sectional Study Of Acute Kidney Injury In Hunan Hospitalized Children

Obejective To study the epidemiological data and economic burden of acute renal injury in hospitalized children aged 0 to 14 years in Hunan province.Methods We conducted a cross-section epidemiological survey from December 2017 to February 2018.The medical records of hospitalized patients aged 0 to 14 years from 8 level Ⅲ hospitals and 12 level Ⅱ hospitals in different regions of the province were collected to analyze the incidence,missed diagnosis rate,main etiology,risk factors and medical expenses of acute kidney injury(AKI).The diagnosis of AKI was based on the following two criteria: 1)the 2012 Kidney Diseases: Improving Global Outcomes criteria,2)(expanded criteria)a decrease in serum creatinine within 48 hours up to 26.5μmol/L(0.3mg/dl),or decreased more than 50% of the baseline value within 7 days,or exceeded the mean value of serum creatinine of normal children of the same age by 50%.Results A total of 32154 patients were included in this study,the average age was 587(192,1632)days,12609 cases(39.2%)were infants.80(0.2%)met the diagnostic criteria of KDIGO,1001(3.1%)met the criteria of expansion.The total number of deaths during hospitalization was 45(0.1%),AKI associated deaths were 18.There were 724(67.0%)with AKI stage 1,271(25.1%)stage 2 and 86(8.0%)stage 3.The highest incidence was 4.8% found in children aged 1 to 3 years,and the lowest was in children over 7 years old,just 1.6%.The incidence of AKI in ICU patients was 2 times higher than that in non-ICU patients.The total rate of missed diagnosis was 96.9%,the diagnostic rate of AKI was zero in the level Ⅱ hospital and 4.3% in the level Ⅲ hospital,respectively.With the increase of AKI stage,the missed diagnosis rate was decreased gragually,the missed diagnosis rate was lower in ICU patients(82.6%)than that of non-ICU patients(98.8%)(P<0.0001),and was lower in hospital acquired AKI patients(91.1%)than that of community-acquired AKI patients(97.4%)(P<0.0001).The main etiology of AKI was secondary renal injury.509 cases(47.1%)of AKI were caused by drugs.Multivariate logistic regression analysis was performed on the risk factors of AKI in all hospitalized patients.Proteinuria,serum albumin(ALB)less than 30 g / L,transfer to ICU during hospitalization were the independent risk factors for the occurrence of AKI.Children under 7 years old had the higher risk than that in children over 7 years old.The risk factors of neonatal AKI were analyzed by multivariate logistic regression analysis,neonatal asphyxia,late neonates,proteinuria,ALB<30g/L,not hospitalized in pediatrics(i.e.in surgery,otorhinolaryngology and other departments)were independent risk factors for neonatal AKI.The risk of death in AKI patients was 16 times higher than that in non-AKI patients.The rate of transfer to ICU during hospitalization was significantly higher than that of non-AKI patients(P<0.0001).The per capita total cost of hospitalization is higher than that of non-AKI patients(P<0.0001).The ICU transfer rate during hospitalization was 8.4%,13.7%,39.5%,the average length of hospitalization were 5.0(4.0,8.0)days,7.0(4.0,11.0)days,10.0(5.8,20.0)days and the average cost of hospitalization was ￥3788.9(1646.9,8120.0),￥8819.2(4445.5,17223.4),￥13556.1(5953.6,32904.6)with AKI stage 1,stage 2 and stage 3,respectively(P<0.0001).Conclusions The incidence(3.4%)and missed diagnosis rate(96.9%)of AKI were high in hospitalized children in Hunan province.The main causes of AKI was renal injury secondary to non-renal disease,the prerenal and postrenal diseases were not common.There were many risk factors for AKI and different risk factors for AKI in children of different age groups.AKI increased the risk of death and costs of hospitalization.With the aggravation of AKI stage,the conversion rate of ICU gradually increased,the per capita hospitalization time was prolonged,and the per capita hospitalization cost increased obviously.