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

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.

Acute Kidney Disease in Hospitalized Pediatric Patients With Acute Kidney Injury in China

“…Studies in relation to AKD in pediatric patients have been scarce. Patel et al investigated the epidemiology of AKD in children after transplant, where AKD was defined as impaired kidney function lasting for <90 days with or without an AKI event and found that AKD occurred in 13% of patients and was independently associated with new-onset CKD ( 14 ). LoBasso et al explored the kidney recovery patterns of AKI and the relationship with hospital outcomes in children undergoing cardiopulmonary bypass ( 15 ).…”

Impaired kidney function >90 days determines long‐term kidney outcomes

“…12,13 It is therefore not surprising that AKI and AKD may lead to CKD in non-renal solid organ transplant recipients, but the epidemiology and the impact of the rather common AKI and AKD in pediatric non-renal solid organ transplant recipients has not previously been described. In that context, we note the important retrospective cohort study by Mital Patel et al, 14 which is published in this edition of Pediatric Transplantation.…”

“…14 In Patel's study, AKD incidence affected 1/6 of the participants, with many of them developing new onset CKD stage 3 (GFR between 30 and 60 ml/min/1.73 m 2 ). 14 In one of the largest studies of CKD after pediatric heart transplantation, 29% of participants had CKD stage 3 at 5 years, and 43% at 10 years post-liver transplantation. 20 It is possible that the cohort by Patel et al 14 has an even higher incidence of CKD stage ≥3, had they measured GFR with gold standard methods such as iohexol, 51 Cr EDTA, or 99 Tc DTPA.…”

“…16 Patel et al comment in their discussion section that microalbuminuria, an additional important tool for the detection of renal dysfunction, was not utilized. 14 This may have resulted in underestimation of the real problem. Nonetheless, the most important teaching from Patel's study is the fact that any AKI lasting longer Abbreviations: AKD, acute kidney disease; AKI, acute kidney injury; CKD, chronic kidney disease; ESKD, end-stage chronic kidney disease; GFR, glomerular filtration rate; IDMS, isotope-dilution mass spectrometry; RAAS, renin-angiotensin-aldosterone system.…”

“…14 In one of the largest studies of CKD after pediatric heart transplantation, 29% of participants had CKD stage 3 at 5 years, and 43% at 10 years post-liver transplantation. 20 It is possible that the cohort by Patel et al 14 has an even higher incidence of CKD stage ≥3, had they measured GFR with gold standard methods such as iohexol, 51 Cr EDTA, or 99 Tc DTPA. 21 We recommend that any pediatric solid organ transplant recipient in whom serum creatinine has not returned to baseline by day 7 should be referred to pediatric nephrology to monitor and treat CKD.…”