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. 2022 Sep;26(6):e14172.
doi: 10.1111/petr.14172. Epub 2021 Oct 20.

Acute kidney disease predicts chronic kidney disease in pediatric non-kidney solid organ transplant patients

Mital Patel  1 , Anna Heipertz  2 , Emily Joyce  3 , John A Kellum  4 , Christopher Horvat  5   6 , James E Squires  7 , Shawn C West  8 , Priyanka Priyanka  4 , Dana Y Fuhrman  4   5   9
Affiliations

Acute kidney disease predicts chronic kidney disease in pediatric non-kidney solid organ transplant patients

Mital Patel et al. Pediatr Transplant. 2022 Sep.

Abstract

Background: Acute kidney disease (AKD) is defined as impaired kidney function present for <90 days with or without an acute kidney injury (AKI) event. Adults with AKD have an increased risk for progression to chronic kidney disease (CKD) and mortality. There are no data on the epidemiology of AKD in children after transplant. The aim of this study was to evaluate the incidence and risk factors for AKI, AKD, and CKD in children after transplantation.

Methods: This is a retrospective cohort study of all children undergoing non-kidney solid organ transplant between 2011 and 2019 at UPMC Children's Hospital of Pittsburgh. AKI and AKD were defined using the Kidney Disease Improving Global Outcomes criteria. Patients with a new estimated glomerular filtration rate <60 ml/min/1.73m2 persisting for >3 months met criteria for new CKD. Variables associated with AKI, AKD, and CKD were analyzed.

Results: Among 338 patients, 37.9% met criteria for severe AKI, 13% for AKD, and 8% for a new diagnosis of CKD. Stage 3 AKI was independently associated with AKD (OR: 5.35; 95% CI: 2.23-12.86). Severe AKI was not associated with new-onset CKD, whereas AKD was associated with new-onset CKD (OR: 29.74; CI: 11.22-78.82).

Conclusion: AKD may be superior to AKI in predicting risk of CKD in children after non-kidney solid organ transplantation.

Keywords: acute kidney disease; acute kidney injury; children; transplantation.

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Figures

Figure 1:
Figure 1:
Criteria used to define acute kidney injury (AKI), acute kidney disease (AKD), and chronic kidney disease (CKD). Baseline creatinine (mg/dL) and eGFR (estimated glomerular filtration rate, mL/min per 1.73 m2) are based on the serum creatinine on the day of, but prior to transplant.
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