Impact of acute kidney injury on long-term mortality and progression to chronic kidney disease among critically ill children

Abstract

To determine the 2-year outcome of acute kidney injury (AKI) following admission to pediatric critical care units (PICU). Methods: A retrospective cohort study was conducted between January 2012 and December 2013. We followed 131 children admitted to PICU, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia with a diagnosis of AKI, based on pRIFLE (pediatric risk, injury, failure, loss, and end-stage renal disease), for 2 years. During the study period, 46 children died and 38 of survivors completed the follow-up. Factors affecting long-term progression to chronic kidney disease were also evaluated. Results: The 2-year mortality was more than 40%. The main determinant of the 2-year mortality was the pediatric risk of mortality (PRISM) score, which increased the risk of mortality by 6% per each one score (adjusted odds ratio, 1.06: 95% confidence interval: 1.00-1.11). By the end of the 2 years, 33% of survivors had reduction in the glomerular filtration rate and proteinuria, and 73% were hypertensive. Patients with more severe renal impairment at admission, based on the pRIFLE criteria, had higher mortality rate. This association, however, was not independent since it was influenced by baseline disease severity (PRISM score). Conclusion: Large proportion of patients admitted to PICU with AKI either died during the first 2 months of follow-up or developed long-term complications. The severity of AKI, however, was not an independent risk factor for mortality.

Figure 1

Kaplan-Meier curve showing survival rate among patients admitted to pediatric intensive care unit with renal impairment

Figure 2

Kaplan-meier curve showing survival rate among patients admitted to pediatric intensive care unit stratified by the extent of renal impairment, based on pediatric risk, injury, failure, loss, and end-stage renal disease (pRIFLE).

Figure 3

Glomerular filtration rate level during 2 years follow-up among patients with normal versus high (30 mg/dl or more) urine protein level at baseline.

Figure 4

Glomerular filtration rate level during 2 years follow-up after admission to pediatric intensive care unit, stratified by the modified pediatric risk, injury, failure, loss, and end-stage renal disease criteria at the time of admission.