Hospitalizations involving acute kidney injury (AKI) among pediatric patients increased tenfold over a 25-year period, according to an analysis of more than 24.3 million discharges published in JAMA Network Open. The rate rose from 15.7 per 10,000 discharges in 1997 to 168.7 per 10,000 in 2022, while AKI requiring dialysis more than doubled from 2.4 to 5.5 per 10,000 discharges.
Despite the surge, in-hospital mortality among pediatric AKI patients improved substantially, dropping from 1,814.0 to 643.4 per 10,000 hospitalizations between 2003 and 2022. However, mortality for those requiring dialysis remained stable at about 25%.
The study authors and editorial commentators agreed that the rising AKI rates should not be seen solely as worsening care. They attributed the increase partly to improved case identification, coding changes, wider availability of dialysis for infants, and the growing complexity of children with congenital heart disease, cancer, transplants, and critical illness who now survive longer.
AKI survivors face increased risks of chronic kidney disease, hypertension, recurrent AKI, and cardiovascular complications. The commentary authors called for stronger post-AKI surveillance, outpatient nephrology follow-up, and more resources for pediatric critical care nephrology programs, especially given workforce shortages in the field.