ESPN 53rd Annual Meeting

ESPN 2021


 
The epidemiology of childhood acute kidney injury in England using AKI e-alerts
LUCY PLUMB 1 ANNA CASULA 1 MANISH SINHA 2 CAROL INWARD 4 STEPHEN MARKS 3 JAMES MEDCALF 1 DOROTHEA NITSCH 1

1- UK RENAL REGISTRY
2- EVELINA LONDON CHILDRENS HOSPITAL
3- UNIVERSITY COLLEGE LONDON GREAT ORMOND STREET INSTITUTE OF CHILD HEALTH, NIHR GREAT ORMOND STREET HOSPITAL BIOMEDICAL RESEARCH CENTRE, LONDON, UK
4- UNIVERSITY HOSPITALS BRISTOL & WESTON NHS FOUNDATION TRUST
 
Introduction:

Few national datasets describe the epidemiology and outcomes of childhood AKI. Since 2014, all NHS laboratories in England are required to issue electronic (e-)alerts for AKI based on changes in serum creatinine. The UK Renal Registry receive these data which are linked to electronic health record data. The aim was to describe a national cohort of children who received an AKI e-alert and their clinical course.

 

Material and methods:

 AKI e-alert data from 01/01/2017- 31/12/2017 are described. Linkage to Hospital Episode Statistics data was undertaken to describe outcomes of hospitalised AKI including length of stay (LOS) and critical care admission (CC). Risk associations with CC (hospitalised cohort) and 30-day mortality (total cohort) are examined using age- and sex-adjusted multivariable logistic regression models.

Results:

Over the study period, 7,788 children (52% male, median age 4.4 years, IQR 0.9-11.5) experienced 8,927 AKI e-alert episodes; 8.2% occurred during birth admissions. Children aged under 5-years accounted for half of all episodes. Of 5,582 children with hospitalised AKI episodes, peak AKI stage 2 was noted in 20.8% and stage 3 in 13.2%. CC occurred in 1,402 (25%): children of Asian ethnicity, in the youngest (<1) or oldest (16-18) age-bands (reference 1-5 years), and with higher peak AKI stages had higher odds of CC. The median LOS was 9 (IQR 4-25) days, with longer LOS in birth-admission episodes. There was strong evidence for higher LOS with higher peak AKI stage. There were 251 deaths within 30-days. Youngest and oldest age-groups, hospital-acquired AKI, higher peak stage, and requiring CC were associated with higher odds of death.

Conclusions:

Young children contributed significantly to the AKI burden. As higher peak AKI stage and hospital-acquired injury were associated with longer LOS and mortality, inpatient-based interventions may minimise morbidity and be cost-effective to healthcare providers.