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Background <p>Acute kidney injury (AKI) is a common and serious complication in critically ill children. Data from Southeast Asia remain limited, particularly from high-acuity pediatric centers. This study evaluated the incidence, associated factors, and outcomes of AKI in a quaternary pediatric intensive care unit (PICU).</p> Methods <p>We conducted a prospective cohort study of children aged &gt; 28&#xa0;days to ≤ 18&#xa0;years admitted to PICU between 1 July 2023 and 30 June 2024. AKI was defined and staged using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Demographic and clinical data were collected, and multivariable logistic regression identified factors associated with AKI. Outcomes were assessed at 30&#xa0;days and 3&#xa0;months for kidney recovery.</p> Results <p>Among 422 children analyzed, 83 (19.7%) developed AKI, predominantly pre-renal (77.1%). Stage 3 AKI occurred in 34.9% at onset and 47.0% at peak within the first week. Older age (adjusted odds ratio [aOR] 1.10 per year, 95%CI 1.04–1.16), sepsis (aOR 2.41, 95%CI 1.32–4.38), and use of multiple inotropes (aOR 5.83, 95%CI 2.73–12.46) were associated with AKI. Kidney replacement therapy (KRT) was required in 21.7%. Overall 30-day mortality was 8.8%, compared with 21.7% among children with AKI. At 3&#xa0;months, AKI resolved in most survivors, although six (7.2%) progressed to chronic kidney disease, including one requiring ongoing dialysis.</p> Conclusions <p>AKI affected one in five critically ill children in this PICU cohort, frequently progressed to severe stages. Associated factors included age, sepsis, and inotropic support. Strategies to prevent AKI and enhance timely access to treatments are warranted to improve outcomes.</p> Graphical abstract <p></p>

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Acute kidney injury in critically ill children: Incidence, severity, and clinical outcomes from a quaternary pediatric intensive care unit in an upper-middle-income country

  • 期刊论文

  • 发表日期：

    2026年5月29日

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  • Siti Fatimah Abu Hussain,
  • Jia Yi Tham,
  • Aznor Fadly Azim,
  • Jia Yueh Chong,
  • Yok Chin Yap

摘要

Background

Acute kidney injury (AKI) is a common and serious complication in critically ill children. Data from Southeast Asia remain limited, particularly from high-acuity pediatric centers. This study evaluated the incidence, associated factors, and outcomes of AKI in a quaternary pediatric intensive care unit (PICU).

Methods

We conducted a prospective cohort study of children aged > 28 days to ≤ 18 years admitted to PICU between 1 July 2023 and 30 June 2024. AKI was defined and staged using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Demographic and clinical data were collected, and multivariable logistic regression identified factors associated with AKI. Outcomes were assessed at 30 days and 3 months for kidney recovery.

Results

Among 422 children analyzed, 83 (19.7%) developed AKI, predominantly pre-renal (77.1%). Stage 3 AKI occurred in 34.9% at onset and 47.0% at peak within the first week. Older age (adjusted odds ratio [aOR] 1.10 per year, 95%CI 1.04–1.16), sepsis (aOR 2.41, 95%CI 1.32–4.38), and use of multiple inotropes (aOR 5.83, 95%CI 2.73–12.46) were associated with AKI. Kidney replacement therapy (KRT) was required in 21.7%. Overall 30-day mortality was 8.8%, compared with 21.7% among children with AKI. At 3 months, AKI resolved in most survivors, although six (7.2%) progressed to chronic kidney disease, including one requiring ongoing dialysis.

Conclusions

AKI affected one in five critically ill children in this PICU cohort, frequently progressed to severe stages. Associated factors included age, sepsis, and inotropic support. Strategies to prevent AKI and enhance timely access to treatments are warranted to improve outcomes.

Graphical abstract