US Pediatric AKI Hospitalization Rate Rose More Than 10-Fold

The annual number of US pediatric hospitalizations complicated by acute kidney injury (AKI) increased more than 10-fold from 1997 to 2022, according to a retrospective national cohort study published in JAMA Network Open. The estimated rate rose from 15.7 to 168.7 cases per 10,000 hospitalizations during the 25-year period.

Investigators analyzed 9 releases of the Healthcare Cost and Utilization Project Kids’ Inpatient Database, an all-payer sample of admissions to pediatric units and children’s hospitals, spanning 1997 to 2022. Of 26,357,519 discharges, 24,344,876 were included after excluding uncomplicated births, hospitalizations involving end-stage kidney disease, and patients with a kidney transplant history. AKI and dialysis use were identified through diagnosis and procedure codes, and weighted estimates were used to calculate national rates.

An estimated 253,138 hospitalizations were complicated by AKI across the 9 study years. Annual AKI hospitalizations increased from 6,318 in 1997 to 63,923 in 2022. The annual percentage increase in the AKI rate was 8.8% from 1997 to 2006, 12.8% from 2006 to 2019, and 5.1% after 2019. Hospitalizations involving AKI requiring dialysis also increased, from 981 to 2,075 annually, while the rate rose from 2.4 to 5.5 per 10,000 hospitalizations.

Among hospitalizations with AKI, mean length of stay declined from 22.7 days in 1997 to 15.2 days in 2022, and recorded mortality decreased from 1,814.0 to 643.4 deaths per 10,000 AKI hospitalizations between 2003 and 2022. Mortality among hospitalizations involving dialysis-treated AKI remained stable at approximately 25%.

The investigators said the increase may reflect improved AKI recognition and documentation, as well as growth in the number of older and medically complex patients receiving pediatric care. Limitations included reliance on administrative codes without laboratory data and the possibility that repeated admissions by the same patient were counted separately.

Source: Kula AJ, Sun S, Terry N, et al. US pediatric hospitalizations complicated by acute kidney injury and dialysis from 1997 to 2022. JAMA Netw Open. 2026;9(9):e2635547. doi:10.1001/jamanetworkopen.2026.35547