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Introduction: Acute kidney injury (AKI) is a common adverse event in hospitalized patients, associated with increased mortality, length of stay, and resource utilization. Rates of AKI in paediatric populations, based on the RIFLE criteria, which uses changes in glomerular filtration rate (GFR) and urine output to classify AKI severity, vary in the literature. These variations can significantly affect the estimated incidence of AKI. Hypothesis: We aimed to quantify the incidence of AKI within a large, academic paediatric intensive care unit (ICU). Methods: All children admitted to The Hospital for Sick Children’s Critical Care Unit between January 2006 and June 2009 were studied, excluding readmissions to the ICU, newborns, patients with short ICU stays (<6 hours), preexisting renal failure, and those with no creatinine and urine output measurements in the ICU. AKI severity was assessed according to the RIFLE criteria (None, ‘Risk’, ‘Injury’ or ‘Failure’) using both the full criteria (changes in both serum creatinine and urine output) and the GFR criteria alone. Descriptive statistics of patient outcomes were reported for both outcome definitions. Results: During the study period, 3,865 patients (56.0% male; median age 4.4 years, IQR 11.1) met the inclusion criteria. 915 patients (23.7%) experienced AKI (maximum severity: 66.0% ‘Risk’, 27.5% ‘Injury’, 6.5% ‘Failure’). 164 patients (17.9%) met both the GFR and urine output criteria, while 22.3% (n=204) experienced only an increase in serum creatinine and 59.8% (n=547) had declining urine output. Based solely on creatinine, the incidence of AKI was 9.5% (n=368; maximum severity: 59.5% ‘Risk’, 29.4% ‘Injury’, 11.1% ‘Failure’). The median ICU length of stay (LOS) for patients with RIFLE-defined AKI was 1 day (IQR=1); based creatinine alone, this increased to 8 days (IQR=11). ICU mortality was 7.2% (95% CI: 5.6–9.1%) for RIFLE-based AKI and 10.6% (95% CI: 7.7–14.2%) using creatinine alone. Conclusions: The RIFLE criteria are inconsistently applied in the literature. Defining AKI solely by creatinine changes may drastically underestimate the incidence of AKI. This definition of AKI also results in higher ICU LOS and mortality, implying that it captures more severe illness.

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