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. 2023 Oct;38(10):3465-3474.
doi: 10.1007/s00467-023-05997-9. Epub 2023 May 5.

Patient level factors increase risk of acute kidney disease in hospitalized children with acute kidney injury

Mital Patel  1 , Christoph Hornik  2 , Clarissa Diamantidis  3 , David T Selewski  4 , Rasheed Gbadegesin  5
Affiliations

Patient level factors increase risk of acute kidney disease in hospitalized children with acute kidney injury

Mital Patel et al. Pediatr Nephrol. 2023 Oct.

Abstract

Background: Studies in adults have shown that persistent kidney dysfunction ≥7-90 days following acute kidney injury (AKI), termed acute kidney disease (AKD), increases chronic kidney disease (CKD) and mortality risk. Little is known about the factors associated with the transition of AKI to AKD and the impact of AKD on outcomes in children. The aim of this study is to evaluate risk factors for progression of AKI to AKD in hospitalized children and to determine if AKD is a risk factor for CKD.

Methods: Retrospective cohort study of children age ≤18 years admitted with AKI to all pediatric units at a single tertiary-care children's hospital between 2015 and 2019. Exclusion criteria included insufficient serum creatinine values to evaluate for AKD, chronic dialysis, or previous kidney transplant.

Results: A total of 528 children with AKI were included in the study. There were 297 (56.3%) hospitalized AKI survivors who developed AKD. Among children with AKD, 45.5% developed CKD compared to 18.7% in the group without AKD (OR 4.0, 95% CI 2.1-7.4, p-value <0.001 using multivariable logistic regression analysis including other covariates). Multivariable logistic regression model identified age at AKI diagnosis, PCICU and NICU admission, prematurity, malignancy, bone marrow transplant, previous AKI, mechanical ventilation, AKI stage, duration of kidney injury, and need for kidney replacement therapy during day 1-7 as risk factors for AKD after AKI.

Conclusions: AKD is common among hospitalized children with AKI and multiple risk factors are associated with AKD. Children that progress from AKI to AKD are at higher risk of developing CKD. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Acute kidney disease; Acute kidney injury; Chronic kidney disease; Epidemiology.

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Conflict of interest statement

Declarations:

Competing Interests: CJD reports consultancy with UnitedHealth Group/Optum Labs. Other authors have no relevant financial or non-financial interests to disclose.

Figures

Figure 1:
Figure 1:
Definitions of AKI, AKD, and CKD Neonatal AKI definition- Stage 1 : SCr ≥0.3 mg/dL rise from baseline or SCr rise ≥1.5–1,9x baseline, Stage 2: SCr rise ≥2–2.9x baseline, stage 3: SCr rise ≥3x baseline or SCr ≥2.5 mg/dL or need for kidney replacement therapy
Figure 2:
Figure 2:
Proportion of patients with AKD by stage of AKI and pairwise comparison for odds of developing AKD by AKI stage
Figure 3.
Figure 3.
Flowchart of CKD incidence after AKD
See this image and copyright information in PMC

References

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