G327(P) An audit of acute kidney injury in children

Aims Acute Kidney Injury (AKI) in hospitalised children is significantly associated with increased morbidity and mortality. The British Association of Paediatric Nephrology AKI management guidelines recommend early identification of patients at high risk for AKI to enable preventative measures to be implemented. This retrospective audit aimed to describe the epidemiology of AKI at a tertiary paediatric centre in order to prioritise interventions. Methods All inpatients with an AKI stage 2 or 3 alert between 1st March and 31st May 2017 were included in this audit. The electronic healthcare record for each patient was accessed and data extracted. Results Over a 3 month period there were 354 AKI stage 2 or 3 alerts accounting for 125 AKI episodes affecting a total of 101 patients. Males (53.5%) and females (46.5%) were evenly represented. Children aged between 1 month and 2 years were most frequently affected (37%). 22% of patients were under the care of cardiology, 12% under general paediatrics, and 11% under respiratory. The majority of episodes lasted only 1 day, with 55 episodes (44%) lasting for 2 or more days. 51% of AKI episodes were associated with exposure to at least one nephrotoxic medication during, or in the 7 days preceding, the event. The most common medications were furosemide (14%), piperacillin with tazobactam (14%) and ibuprofen (11%). Overall the cause of AKI was infrequently documented (37% of episodes), however, where documented, the leading causes were cardiac surgery (28%) and nephrotoxic medications (20%). Conclusion Cardiac surgery represents a significant risk factor for the development of AKI in children. In addition, over half of children who developed AKI were exposed to nephrotoxic medications, and this was the second most common identified cause. Future AKI management strategies should focus on delivering improvements for these groups of patients to reduce the impact of AKI.