Acute kidney injury in hospitalized children: consequences and outcomes

Abstract

Over the past decade, the nephrology and critical care communities have adopted a consensus approach to diagnosing acute kidney injury (AKI) and, as a result, we have seen transformative changes in our understanding of pediatric AKI epidemiology. The data regarding outcomes among neonates and children who develop AKI have become far more robust and AKI has been clearly linked with an increased need for mechanical ventilation, longer inpatient stays, and higher mortality. Though AKI was historically thought to be self-limited, we now know that renal recovery is far from universal, particularly when AKI is severe; the absence of recovery from AKI also carries longitudinal prognostic implications. AKI survivors, especially those without full recovery, are at risk for chronic renal sequelae including proteinuria, hypertension, and chronic kidney disease. This review comprehensively describes AKI-related outcomes across the entire pediatric age spectrum, using the most rigorous studies to identify the independent effects of AKI events.

Keywords: AKI; Acute kidney injury; Children; Chronic kidney disease; Length of stay; Mortality; Neonates; Renal recovery.

Fig. 1

Outcomes among children who develop acute kidney injury (AKI). Children who develop AKI while hospitalized are at risk for poorer short- and mid/long-term outcomes. Across both acute and critical care populations, AKI is associated with longer lengths of stay, non-recovery of baseline renal function, and chronic renal disease including proteinuria, hypertension, and chronic kidney disease (CKD). Children receiving critical care who develop AKI are more likely to require prolonged mechanical ventilation support and experienced higher mortality. eGFR estimated glomerular filtration rate, LOS length of stay

Fig. 2

Mortality in hospitalized children according to acute kidney injury (AKI) severity stage [1]. In acute care environments, mortality among children with and without AKI was similar regardless of AKI severity (p > 0.05). In children receiving critical care, mortality was higher among children who experienced AKI than those who did not. There was a dose-dependent effect as mortality was higher at each successive severity stage. The increases at stage 3 and stage 1 were statistically significant when compared with the prior stage (p < 0.05). All stages had significantly higher mortality than patients without AKI (p < 0.05)