Healthcare Utilization after Acute Kidney Injury in the Pediatric Intensive Care Unit

Abstract

<div class="section"> <a class="named-anchor" id="d3478813e198"> <!-- named anchor --> </a> <h5 class="section-title" id="d3478813e199">Background and objectives</h5> <p id="d3478813e201">Little is known about the long-term burden of AKI in the pediatric intensive care unit. We aim to evaluate if pediatric AKI is associated with higher health service use post–hospital discharge. </p> </div><div class="section"> <a class="named-anchor" id="d3478813e203"> <!-- named anchor --> </a> <h5 class="section-title" id="d3478813e204">Design, setting, participants, &amp; measurements</h5> <p id="d3478813e206">This is a retrospective cohort study of children (≤18 years old) admitted to two tertiary centers in Montreal, Canada. Only the first admission per patient was included. AKI was defined in two ways: serum creatinine alone or serum creatinine and/or urine output. The outcomes were 30-day, 1-year, and 5-year hospitalizations, emergency room visits, and physician visits per person-time using provincial administrative data. Univariable and multivariable Poisson regression were used to evaluate AKI associations with outcomes. </p> </div><div class="section"> <a class="named-anchor" id="d3478813e208"> <!-- named anchor --> </a> <h5 class="section-title" id="d3478813e209">Results</h5> <p id="d3478813e211">A total of 2041 children were included (56% male, mean admission age 6.5±5.8 years); 299 of 1575 (19%) developed AKI defined using serum creatinine alone, and when urine output was included in the AKI definition 355 of 1622 (22%) children developed AKI. AKI defined using serum creatinine alone and AKI defined using serum creatinine and urine output were both associated with higher 1- and 5-year hospitalization risk (AKI by serum creatinine alone adjusted relative risk, 1.42; 95% confidence interval, 1.12 to 1.82; and 1.80; 1.54 to 2.11, respectively [similar when urine output was included]) and higher 5-year physician visits (adjusted relative risk, 1.26; 95% confidence interval, 1.14 to 1.39). AKI was not associated with emergency room use after adjustments. </p> </div><div class="section"> <a class="named-anchor" id="d3478813e213"> <!-- named anchor --> </a> <h5 class="section-title" id="d3478813e214">Conclusions</h5> <p id="d3478813e216">AKI is independently associated with higher hospitalizations and physician visits postdischarge. </p> </div><p class="first" id="d3478813e219"> <div class="fig panel" id="absf1"> <a class="named-anchor" id="absf1"> <!-- named anchor --> </a> <div class="figure-container so-text-align-c"> <img alt="" class="figure" src="/document_file/d1f55592-4ecf-4e13-bb5a-309444b697db/PubMedCentral/image/CJN.09350817absf1"/> </div> <div class="panel-content"/> </div> </p>