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. 2014 Nov 21:15:184.
doi: 10.1186/1471-2369-15-184.

Long-term risk of chronic kidney disease and mortality in children after acute kidney injury: a systematic review

Jason H Greenberg, Steven Coca, Chirag R Parikh  1
Affiliations

Long-term risk of chronic kidney disease and mortality in children after acute kidney injury: a systematic review

Jason H Greenberg et al. BMC Nephrol. .

Abstract

Background: Acute kidney injury (AKI) is associated with significant short-term morbidity and mortality in children. However, the risk for long-term outcomes after AKI is largely unknown.

Methods: We performed a systematic review and meta-analysis to determine the cumulative incidence rate of proteinuria, hypertension, decline in glomerular filtration rate (GFR), and mortality after an episode of AKI. After screening 1934 published articles from 1985-2013, we included 10 cohort studies that reported long-term outcomes after AKI in children.

Results: A total of 346 patients were included in these studies with a mean follow-up of 6.5 years (range 2-16) after AKI. The studies were of variable quality and had differing definitions of AKI with five studies only including patients who required dialysis during an AKI episode. There was a substantial discrepancy in the outcomes across these studies, most likely due to study size, disparate outcome definitions, and methodological differences. In addition, there was no non-AKI comparator group in any of the published studies. The cumulative incidence rates for proteinuria, hypertension, abnormal GFR (<90 ml/min/1.73 m2), GFR < 60 ml/min/1.73 m2, end stage renal disease, and mortality per 100 patient-years were 3.1 (95% CI 2.1-4.1), 1.4 (0.9-2.1), 6.3 (5.1-7.5), 0.8 (0.4 -1.4), 0.9 (0.6-1.4), and 3.7 (2.8-4.5) respectively.

Conclusions: AKI appears to be associated with a high risk of long-term renal outcomes in children. These findings may have implications for care after an episode of AKI in children. Future prospective studies with appropriate non-AKI comparator groups will be required to confirm these results.

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Figures

Figure 1
Figure 1
Selection of studies.
Figure 2
Figure 2
Long-term mortality in various pediatric cohorts.
Figure 3
Figure 3
Cumulative long-term rates of renal outcomes and mortality.
See this image and copyright information in PMC

References

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Pre-publication history
    1. The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2369/15/184/prepub

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