Acute Kidney Injury in Critically Ill Children: A Retrospective Single-Center Study

Background and Objective: Acute kidney injury (AKI) is an important contributor to morbidity and mortality in critically ill children. This study aimed to determine the incidence, clinical characteristics, and outcomes of AKI in a tertiary pediatric intensive care unit (PICU). Methods: We conducted a retrospective observational cohort study at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from January 2018 to December 2022. Children aged 29 days to 14 years who were admitted to the PICU for ≥48 h were included. AKI was defined and staged according to the 2012 KDIGO criteria. Neonates, patients with chronic kidney disease, elective or post-operative admissions, and patients with do-not-resuscitate orders were excluded. Results: Of 1200 eligible admissions, 162 (13.5%) developed AKI: Stage 1, 44 (27.2%); Stage 2, 64 (39.5%); and Stage 3, 54 (33.3%). Greater AKI severity was associated with younger age, greater inotropic requirement, and longer mechanical ventilation (all p < 0.05). Renal replacement therapy was used in 4.3% of the cohort. Overall PICU mortality was 16.7% and increased to 27.8% in Stage 3 AKI (p = 0.006). Inotropic support (adjusted OR 8.51; p < 0.001), number of complications (adjusted OR 4.38; p < 0.001), and PRISM IV score (adjusted OR 1.07; p = 0.042) were associated with mortality in the multivariable model; gender was not significant (adjusted OR 2.24; p = 0.212). Conclusions: AKI severity was associated with worse clinical outcomes. Early recognition, hemodynamic stabilization, timely nephrology involvement, and post-AKI follow-up are important components of care.