Acute Kidney Injury Epidemiology, Risk Factors, and Outcomes in Critically Ill Patients 16-25 Years of Age Treated in an Adult Intensive Care Unit

Overview

Journal Ann Intensive Care

Specialty Critical Care

Date 2018 Feb 16

PMID 29445884

Citations 32

Authors

Dana Y Fuhrman

Sandra Kane-Gill

Stuart L Goldstein

Priyanka Priyanka

John A Kellum

Affiliations

Soon will be listed here.

Abstract

Background: Most studies of acute kidney injury (AKI) have focused on older adults, and little is known about AKI in young adults (16-25 years) that are cared for in an adult intensive care unit (ICU). We analyzed data from a large single-center ICU database and defined AKI using the Kidney Disease Improving Global Outcomes criteria. We stratified patients 16-55 years of age into four age groups for comparison and used multivariable logistic regression to identify associations of potential susceptibilities and exposures with AKI and mortality.

Results: AKI developed in 52.6% (n = 8270) of the entire cohort and in 39.8% of the young adult age group (16-25 years). The AUCs for the age categories were similar at 0.754, 0.769, 0.772, and 0.770 for the 16-25-, 26-35-, 36-45-, and 45-55-year age groups, respectively. For the youngest age group, diabetes (OR 1.89; 95% CI 1.09-3.29), surgical reason for admission (OR 1.79; 95% CI 1.44-2.23), severity of illness (OR 1.02; 95% CI 1.02-1.03), hypotension (OR 1.13; 95% CI 1.04-1.24), and certain medications (vancomycin and calcineurin inhibitors) were all independently associated with AKI. AKI was a significant predictor for longer length of stay, ICU mortality, and mortality after discharge.

Conclusions: AKI is a common event for young adults admitted to an adult tertiary care center ICU with an associated increased length of stay and risk of mortality. Potentially modifiable risk factors for AKI including medications were identified for all stratified age groups.

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References

Hoste E, Bagshaw S, Bellomo R, Cely C, Colman R, Cruz D . Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015; 41(8):1411-23. DOI: 10.1007/s00134-015-3934-7. View

Basu R, Zappitelli M, Brunner L, Wang Y, Wong H, Chawla L . Derivation and validation of the renal angina index to improve the prediction of acute kidney injury in critically ill children. Kidney Int. 2013; 85(3):659-67. PMC: 4659420. DOI: 10.1038/ki.2013.349. View

Edwards J, Houtrow A, Vasilevskis E, Dudley R, Okumura M . Multi-institutional profile of adults admitted to pediatric intensive care units. JAMA Pediatr. 2013; 167(5):436-43. PMC: 3700534. DOI: 10.1001/jamapediatrics.2013.1316. View

Hui-Stickle S, Brewer E, Goldstein S . Pediatric ARF epidemiology at a tertiary care center from 1999 to 2001. Am J Kidney Dis. 2005; 45(1):96-101. DOI: 10.1053/j.ajkd.2004.09.028. View

Zavada J, Hoste E, Cartin-Ceba R, Calzavacca P, Gajic O, Clermont G . A comparison of three methods to estimate baseline creatinine for RIFLE classification. Nephrol Dial Transplant. 2010; 25(12):3911-8. DOI: 10.1093/ndt/gfp766. View

Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W . Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol. 2007; 18(4):1292-8. DOI: 10.1681/ASN.2006070756. View

Liano F, Pascual J . Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int. 1996; 50(3):811-8. DOI: 10.1038/ki.1996.380. View

Levey A, Stevens L, Schmid C, Zhang Y, Castro 3rd A, Feldman H . A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9):604-12. PMC: 2763564. DOI: 10.7326/0003-4819-150-9-200905050-00006. View

Akcan-Arikan A, Zappitelli M, Loftis L, Washburn K, Jefferson L, Goldstein S . Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007; 71(10):1028-35. DOI: 10.1038/sj.ki.5002231. View

10.

Brivet F, Kleinknecht D, Loirat P, Landais P . Acute renal failure in intensive care units--causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure. Crit Care Med. 1996; 24(2):192-8. DOI: 10.1097/00003246-199602000-00003. View

11.

Groeneveld A, Tran D, van der Meulen J, Nauta J, Thijs L . Acute renal failure in the medical intensive care unit: predisposing, complicating factors and outcome. Nephron. 1991; 59(4):602-10. DOI: 10.1159/000186651. View

12.

Cartin-Ceba R, Kashiouris M, Plataki M, Kor D, Gajic O, Casey E . Risk factors for development of acute kidney injury in critically ill patients: a systematic review and meta-analysis of observational studies. Crit Care Res Pract. 2012; 2012:691013. PMC: 3513719. DOI: 10.1155/2012/691013. View

13.

Sutherland S, Zappitelli M, Alexander S, Chua A, Brophy P, Bunchman T . Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis. 2010; 55(2):316-25. DOI: 10.1053/j.ajkd.2009.10.048. View

14.

Kaddourah A, Basu R, Bagshaw S, Goldstein S . Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults. N Engl J Med. 2016; 376(1):11-20. PMC: 5322803. DOI: 10.1056/NEJMoa1611391. View

15.

Sutherland S, Byrnes J, Kothari M, Longhurst C, Dutta S, Garcia P . AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions. Clin J Am Soc Nephrol. 2015; 10(4):554-61. PMC: 4386245. DOI: 10.2215/CJN.01900214. View

16.

Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I . External validation of severity scoring systems for acute renal failure using a multinational database. Crit Care Med. 2005; 33(9):1961-7. DOI: 10.1097/01.ccm.0000172279.66229.07. View

17.

Janse A, Uiterwaal C, Gemke R, Kimpen J, Sinnema G . A difference in perception of quality of life in chronically ill children was found between parents and pediatricians. J Clin Epidemiol. 2005; 58(5):495-502. DOI: 10.1016/j.jclinepi.2004.09.010. View

18.

Bailey D, Phan V, Litalien C, Ducruet T, Merouani A, Lacroix J . Risk factors of acute renal failure in critically ill children: A prospective descriptive epidemiological study. Pediatr Crit Care Med. 2007; 8(1):29-35. DOI: 10.1097/01.pcc.0000256612.40265.67. View

19.

Kane-Gill S, Sileanu F, Murugan R, Trietley G, Handler S, Kellum J . Risk factors for acute kidney injury in older adults with critical illness: a retrospective cohort study. Am J Kidney Dis. 2014; 65(6):860-9. PMC: 4442750. DOI: 10.1053/j.ajkd.2014.10.018. View

20.

Hoste E, Clermont G, Kersten A, Venkataraman R, Angus D, De Bacquer D . RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006; 10(3):R73. PMC: 1550961. DOI: 10.1186/cc4915. View