Bernardo EO, et al. - This investigation was performed with goal to determine the incidence of community-acquired acute kidney injury (CA-AKI) and the frequency of clinician identified CA-AKI to better inform future nephroprotective interventions. Researchers identified CA-AKI to be an underrecognized entity in the Pediatric Emergency Department (PED). For early recognition of AKI in the busy PED environment, better tools are required.

Methods

• Researchers performed a retrospective cross-sectional study in the PED of a children's hospital.
• They included children 1 month to 18 years of age seen in the PED from January 1 to December 31, 2015, and in whom at least one creatinine level was obtained.
• They excluded patients with chronic kidney disease or end-stage renal disease or who died in the PED.
• In this study, patients had CA-AKI based on modified Kidney Disease-Improving Global Outcomes criteria using the creatinine obtained in the PED compared to age-specific norms.
• If the PED clinician diagnosed AKI, patients were considered to be identified.
• Incidence of CA-AKI was the primary outcome.
• Frequency of AKI identification, nephrotoxic medication use, hospital length of stay, renal replacement therapy, and death were included as secondary outcomes.
• They used Fisher exact test or Pearson's chi-square test to calculate odds ratio (OR) with 95% confidence intervals (CIs); multivariable analyses were performed using logistic regression.

Results

• Researchers identified 119,151 PED visits in 2015; of these, 15,486 met inclusion criteria.
• In 239 of 15,486 (1.5%) encounters, CA-AKI was present.
• PED clinicians identified AKI in 46 of 239 (19%) of encounters and the inpatient team identified AKI in 123 of 199 (62%) of the encounters admitted.
• In 74 of 199 (37%) encounters, AKI was never recognized by a PED or inpatient clinician.
• They noted that encounters with AKI correctly diagnosed were older (13 years old vs 10 years old, p=0.0114), had more severe (stage 2 or 3) AKI (OR = 5.5, 95% CI = 2.6–11.8), and were more likely to be admitted (OR = 10.3, 95% CI = 1.38–77.4) than encounters with missed AKI.