Incidence and Outcome of Community-Acquired Acute Kidney Injury in Pediatric Patients Seen at an Emergency Department: A Retrospective Cohort Study.

Objectives: Acute kidney injury (AKI) has significant morbidity and mortality rates among young patients. This study aimed to determine the incidence and outcome of community-acquired AKI among pediatric patients seen in the emergency department of King Abdulaziz University Hospital for more than 3 years.

Methods: This retrospective study reviewed electronic medical records for all pediatric patients aged 1 month to 18 years who visited the emergency department of King Abdulaziz University Hospital from January 1, 2015, until December 31, 2017. Acute kidney injury was diagnosed and classified according to the Kidney Disease: Improving Global Outcomes criteria.

Results: Of 6038 patients, 1581 were included. Acute kidney injury occurred in 135 patients (8.5%), of which 77 (57%) were in stage 1, 42 (31.1%) were in stage 2, and 16 (11.9%) were in stage 3. Mortality was higher in the AKI group (4.4%) than in the non-AKI group (0.2%; P < 0.01). On long-term observation, 14.8% did not return for follow-up, 58.5% of survivors recovered completely, and 22.2% progressed to chronic kidney disease. The most affected age group was 1 month to 2 years (26%). Common admission causes were chemotherapy-induced AKI (31.9%) and pneumonia (10.4%). There was a significant inverse relationship between AKI and age group (P < 0.001) and a positive association between AKI and death (P < 0.001). However, no association was found between AKI stages and outcomes.

Conclusions: Community-acquired AKI remains a common condition affecting the pediatric population. It is associated with a higher mortality rate. Infants were more susceptible to AKI, and a significant number of patients with AKI progressed to chronic kidney disease.