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Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Understanding and improving practice patterns of acute kidney injury (AKI) diagnosis in hospitalized children is needed to mitigate AKI-related short- and long-term health risks. Our objective was to Determine the incidence and ascertainment of AKI in hospitalized children, the frequency of serum creatinine (SCr) re-measurement in hospitalized children with AKI, and documentation of AKI in electronic medical records (EMR).
Retrospective cohort study; >3 months and <18 years old admitted >24 hours, January 2021 – December 2022 (one admission per patient selected at random). Outcomes: SCr measurement (yes/no); AKI per KDIGO SCr criteria; AKI diagnosis code in electronic medical record (EMR); measurement of SCr following index AKI. The sensitivity and specificity analysis of AKI diagnosis in EMR was evaluated.
10,802 unique admissions: 9,059 had ≥1 SCr measurement. AKI occurred in 12% of admissions with at least 1 SCr measurement, with 72% of all AKI being present within 24 hours of admission. The mean time to AKI if not present on admission was 8.9 days. The mean length of hospital stay was 8.2 days longer in patients with AKI. All-cause mortality was higher in patients with AKI (AKI 8.3% vs Non-AKI 2.1%, p <0.001). For patients with AKI, 69% had repeat SCr within 24 hours, 73% had at least one repeat after 24 hours, 38% had daily SCr for 3 consecutive days after AKI onset. Multivariate analysis revealed that admission to the intensive care unit (ICU) before AKI was significantly associated with any SCr remeasurement before discharge (OR 5.26, p <0.001) and SCr remeasurement for 3 consecutive days after index AKI (OR 1.82, p <0.003). 67% of patients with AKI had renal recovery (SCr <1.5x baseline) prior to hospital discharge. The sensitivity and specificity of health records AKI diagnosis were 5.5% and 99.9%, respectively, with sensitivity increasing based on AKI severity (Stage 1: 2%, Stage 2: 4.9%, Stage 3: 20.1%).
Total unique admissions, N = 10,802
SCr measured during admission, N = 9,059
AKI as per KDIGO SCr criteria
Yes (N) = 1,083
No (N) = 7,976
Age (in years)
7.1 (SD)
8.3 (SD)
Baseline SCra, N (%)
761 (70.3)
2,780 (34.9)
AKI onset within 24 hours of admission, N (%)
780 (72.0)
N/A
AKI onset after 24 hours of admission, N (%)
303 (27.9)
Mean time to AKI in days if not present on admission (SD)
8.95 (11.6)
ICU admission, N (%)
453 (41.8)
1,197 (15.0)
Cardiac surgery during admission, N (%)
138 (12.7)
282 (3.5)
Mean length of hospital stay in days (SD)
14.2 (27.9)
5.9 (8.2)
All-cause mortality, N (%)
90 (8.3)
166 (2.1)
SCr – serum creatinine, AKI – acute kidney injury, SD – standard deviation, ICU – intensive care unit
a Defined as the lowest measured SCr in the last 6 months before admission
AKI as per KDIGO SCr criteria, N = 1,083
Repeat SCr within 24 hours of index AKI onset, N (%)
750 (69.3)
Repeat SCr after 24 hours of index AKI onset N (%)
790 (72.9)
Daily repeat SCr for 3 consecutive days after AKI onset, N (%)
416 (38.4)
Renal recovery prior to hospital dischargea, N (%)
729 (67.3)
SCr measured within 72 hours before discharge, N (%)
747 (69.0)
SCr measured within 3 months after discharge, N (%)
557 (51.4)
Stratified by AKI grade
Stage 1
Stage 2
Stage 3
N (%)
650 (60)
264 (24.4)
169 (15.6)
399 (61.4)
198 (75.0)
153 (90.5)
Repeat SCr after 24 hours of index AKI onset, N (%)
422 (64.9)
209 (79.2)
159 (94.1)
Renal recovery (<1.5x baseline) prior to discharge on last SCr measurement, N (%)
466 (71.7)
168 (63.6)
95 (56.2)
SCr measured within 72 hours of discharge, N (%)
404 (62.2)
199 (75.4)
144 (85.2)
SCr – serum creatinine, AKI – acute kidney injury, SD – standard deviation
a Defined as <1.5x baseline kidney function
Sensitivity of EMR diagnosis
Specificity of EMR diagnosis
Any AKI (N = 1,083)
5.5%
99.9%
Stage 1 (N = 650)
2.0%
Stage 2 (N = 264)
4.9%
Stage 3 (N = 169)
20.1%
EMR – electronic medical records
AKI is common and clinically significant, yet highly under-reported in hospitalized children. Future research should elucidate reasons for underreporting and evaluate the impact of improving reporting on patient and system outcomes.
