Acute kidney injury epidemiology, risk factors, and outcomes in critically ill patients 16–25 years of age treated in an adult intensive care unit

Dana Y. Fuhrman, Sandra Kane-Gill, Stuart L. Goldstein, Priyanka Priyanka, John A. Kellum

Most studies of acute kidney injury (AKI) have focused on older adults, and little is known about AKI in young adults (16-25 years) that are cared for in an adult intensive care unit (ICU). We analyzed data from a large single-center ICU database and defined AKI using the Kidney Disease Improving Global Outcomes criteria. We stratified patients 16-55 years of age into four age groups for comparison and used multivariable logistic regression to identify associations of potential susceptibilities and exposures with AKI and mortality. AKI developed in 52.6% (n = 8270) of the entire cohort and in 39.8% of the young adult age group (16-25 years). The AUCs for the age categories were similar at 0.754, 0.769, 0.772, and 0.770 for the 16-25-, 26-35-, 36-45-, and 45-55-year age groups, respectively. For the youngest age group, diabetes (OR 1.89; 95% CI 1.09-3.29), surgical reason for admission (OR 1.79; 95% CI 1.44-2.23), severity of illness (OR 1.02; 95% CI 1.02-1.03), hypotension (OR 1.13; 95% CI 1.04-1.24), and certain medications (vancomycin and calcineurin inhibitors) were all independently associated with AKI. AKI was a significant predictor for longer length of stay, ICU mortality, and mortality after discharge. AKI is a common event for young adults admitted to an adult tertiary care center ICU with an associated increased length of stay and risk of mortality. Potentially modifiable risk factors for AKI including medications were identified for all stratified age groups.