Pediatric community-acquired acute kidney injury at a quaternary-care emergency department: clinical outcomes and prognostic determinants

Community-acquired acute kidney injury (CA-AKI) in children is less well characterized than hospital-acquired AKI but may be associated with serious clinical outcomes. This study evaluated the clinical characteristics, etiologic distribution, short-term renal outcomes, and prognostic indicators of pediatric CA-AKI cases hospitalized after presentation to a quaternary-care pediatric emergency department. In this retrospective cohort study conducted between September 2019 and April 2022, children aged 1 month to < 18 years diagnosed with AKI at presentation or within the first 48 h and hospitalized for ≥ 48 h were included. AKI was staged using the KDIGO 2012 serum creatinine criteria. Associations of clinical, laboratory, and treatment-related variables with prognosis were analyzed. A total of 145 patients were included; 40.6% were classified as KDIGO stage 3. Intrinsic renal etiologies (49.0%) and prerenal causes (46.9%) predominated. Pediatric intensive care was required in 32.4% of cases, and 17.2% received renal replacement therapy (RRT). The median length of hospitalization was 8 days, and the median time to recovery was 4 days. At discharge, 64.8% achieved complete recovery and 17.2% partial recovery. Overall mortality was 13.1%, including 11.0% AKI-related deaths. Anuria, hypotension, lower admission eGFR, and RRT requirement were significantly associated with mortality. Although KDIGO stage was associated with total length of hospitalization and PICU requirement, mortality did not differ across stages. Renal function parameters during follow-up were comparable among KDIGO stages. A substantial proportion of pediatric CA-AKI cases presented at advanced stages and imposed a considerable clinical burden. Our findings suggest that the severity distribution and clinical outcomes of CA-AKI may vary according to healthcare context, and that even in well-resourced settings, children may present across the full spectrum of AKI severity. Not applicable. This study does not involve any clinical trials. Therefore, no clinical trial registration is required.