Height-dependent and height-independent bSCr estimation methods were comparable. This may have significant implications for performing pediatric AKI research using large databases, and in clinical care to define AKI when height is unknown.
Background:The progression from acute kidney injury (AKI) to chronic kidney disease
(CKD) is not well understood in children.Objectives:We aimed to develop a pediatric CKD definition using administrative data and
use it to evaluate the association between AKI in critically ill children
and CKD 5 years after hospital discharge.Design:Retrospective cohort study using chart collection and administrative
data.Setting:Two-center study in Montreal, Canada.Patients:Children (≤18 years old) admitted to two pediatric intensive care units
(ICUs) between 2003 and 2005. We a priori excluded patients with end-stage
renal disease or no health care number. Only the first admission during the
study period was included. We excluded patients who could not be linked to
administrative data, did not survive hospitalization, or had preexisting
renal disease.Measurements:Acute kidney injury was defined using Kidney Disease: Improving Global
Outcomes (KDIGO) criteria. Patients were defined as having CKD 5 years
post-discharge if they had ≥1 CKD diagnostic code or ≥1 CKD-specific
medication prescription.Methods:Chart data used to define the exposure (AKI) were merged with provincial
administrative data used to define the outcome (CKD). Cox regression was
used to evaluate the AKI-CKD association.Results:A total of 2235 (56% male) patients were included, and the median admission
age was 3.7 years. A total of 464 (21%) patients developed AKI during
pediatric ICU admission. At 5 years post-discharge, 43 (2%) patients had a
CKD diagnosis. Patients with both stage 1 and stage 2-3 AKI had increased
risk of a CKD diagnosis, with the adjusted hazard ratios (95% confidence
intervals) of 2.2 (1.1-4.5) and 2.5 (1.1-5.7), respectively
(P < .001).Limitations:Results may not be generalizable to non-ICU patients. We were not able to
control for post-discharge variables; future research should try to explore
these additional potential risk factors further.Conclusions:Acute kidney injury is associated with 5-year post-discharge CKD diagnosis
defined by administrative health care data.
AKI is associated with 5- to 7-year mortality. Because this is an observational study we cannot determine if AKI is causative of mortality or of the pathophysiology. However, patients with AKI represent a high-risk group. It is reasonable that these patients be considered for targeted follow-up until future researchers better elucidate these relationships.
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