Prospective observational studies don't directly change practice, but rather help point out problems that require new approaches. This is one such study, but actually the best part about it, better than the article and the accompanying journal editorial, is Dr. Singer's AAP Grand Rounds commentary!
Source: Kaddourah A, Basu RK, Bagshaw SM, et al. Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med. 2017;376(1):11-20; doi:10.1056/NEJMoa1611391. See AAP Grand Rounds commentary by Dr. Pamela Singer (subscription required).
First, the bottom line. This was a fairly large, multinational observational study, called the Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology (AWARE) study, trying to determine acute kidney injury (AKI) rates and associated factors in children hospitalized in pediatric intensive care units. (More on AWARE later.) With data covering 28-day outcomes in 4683 patients, the rates of all AKI and severe AKI were about 27% and 12%, respectively. These compare with rates in adults in similar situations of 57% and 39%, taken from other studies. In the children, severe AKI was associated with increased mortality, not surprisingly. The primary advantage of knowing these rates is to use as benchmarks for interventions aimed at decreasing AKI in this population.
Which brings us to Dr. Singer's AAP Grand Rounds commentary. She called attention to a study published last year that was just such an intervention, termed the Nephrotoxic Injury Negated by Just-in-time Action (NINJA) study. It was aimed at lowering the rate and severity of AKI in hospitalized children. I was surprised that neither the AWARE study, nor the accompanying NEJM editorial, mentioned the NINJA study. (I was especially surprised since the first author of that study is an author of the current study.)
The NINJA study actually concerns AKI due to nephrotoxic medication exposure in non-critically ill children, which is perhaps why it wasn't referenced in AWARE. Still, I was intrigued with the study, especially since 4 of the top 5 offenders were antimicrobial agents, near and dear to my infectious-disease-specialist heart. The investigators reported on a quality improvement project at 1 pediatric hospital that decreased AKI associated with medications by 64%; pretty impressive.
One final note: I didn't last even 1 year before I'm whining again about nonsensical acronyms for medical trials, last appearing in these pages on May 31, 2016. AWARE and NINJA give little hint that these studies deal with renal injury, but I guess it's a convenient shorthand, and maybe it gives the investigators a bit of a chuckle to come up with these ideas. I'm hoping to forget these terms very soon; I don't want them to become the print equivalent of an earworm, though I could always get some chewing gum.
