Acute Kidney Injury in Critically Ill Children and Subsequent Chronic Kidney Disease

Hessey, Erin; Perreault, Sylvie; Dorais, Marc; Roy, Louise; Zappitelli, Michael

doi:10.1177/2054358119880188

Cited by 55 publications

(53 citation statements)

References 41 publications

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“…Adult studies have used databases to evaluate the association between AKI and long-term CKD development ( 22 ). In the pediatric literature, studies have started exploring the use of administrative data; however, the algorithms used to define CKD and hypertension have not yet been validated ( 26 , 28 ). A validation study of long-term kidney outcome definitions with administrative data would allow for much larger population based studies with longer follow-up times.…”

Section: Discussionmentioning

confidence: 99%

“…The follow-up time across these studies varied from 2 to 6 years, as did the methods of defining outcomes. However, consistently across all studies patients with mixed etiology, PICU-AKI were at higher risk of developing hypertension, proteinuria, and/or CKD over the long-term (15,(26)(27)(28). Two studies in cohorts of general PICU-AKI patients measured outcomes using laboratory defined CKD (albumin/creatinine >30 mg/g or GFR <90 ml/min/1.73 m 2 ) or measured office blood pressure abnormalities (15,27).…”

Section: General Picu Populationmentioning

confidence: 99%

“…One of these studies by Benisty (27). Two studies from the same cohort in Quebec alternatively used administrative data (diagnostic and medication codes) to define CKD and hypertension outcomes (26,28). In this large two-center retrospective cohort of 2,245 subjects, even following mild (stage 1) AKI, children had a significantly increased risk of CKD diagnosis after a 5-year follow-up period (26)…”

Section: General Picu Populationmentioning

confidence: 99%

“…Those with mild AKI (stage 1) had an increased risk of CKD with an adjusted hazard ratio of 2.2 [95% CI:1.1–4.5]. Those with more severe AKI (stage 2 or 3) had a higher risk of CKD with an adjusted hazard ratio of 2.5 [95% CI: 1.1–5.7] ( 26 ). Looking exclusively at hypertension diagnosis based on administrative data in the same large two-center cohort, Hessey et al found that patients with PICU-AKI had over twice the risk of a hypertension diagnosis with an adjusted hazard ratio of 2.19 [95% CI: 1.47–3.26] ( 28 ).…”

Section: Hypertension Proteinuria and Chronic Kidney Diseasementioning

confidence: 99%

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Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years

et al. 2021

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Acute kidney injury (AKI) in the pediatric intensive care unit (PICU) is an important risk factor for increased morbidity and mortality during hospitalization. Over the past decade, accumulated data on children and young people indicates that acute episodes of kidney dysfunction can have lasting consequences on multiple organ systems and health outcomes. To date, there are no guidelines for follow-up of surviving children that may be at risk of long-term sequelae following AKI in the PICU. This narrative review aims to describe literature from the last 5 years on the risk of medium and long-term kidney and non-kidney outcomes after AKI in the PICU. More specifically, we will focus on outcomes in children and young people following AKI in the general PICU population and children undergoing cardiac surgery. These outcomes include mortality, hypertension, proteinuria, chronic kidney disease, and healthcare utilization. We also aim to highlight current gaps in knowledge in medium and long-term outcomes in this pediatric population. We suggest a framework for future research to develop evidence-based guidelines for follow-up of children surviving an episode of critical illness and AKI.

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Section: Discussionmentioning

confidence: 99%

Section: General Picu Populationmentioning

confidence: 99%

Section: General Picu Populationmentioning

confidence: 99%

Section: Hypertension Proteinuria and Chronic Kidney Diseasementioning

confidence: 99%

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Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years

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“…The importance of AKI in sepsis is not just tied to mortality, but also to chronic kidney disease and neurologic disability in surviving children. 5 , 9 , 13 – 16 …”

Section: Introductionmentioning

confidence: 99%

Clinical phenotypes of acute kidney injury are associated with unique outcomes in critically ill septic children

et al. 2021

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Background Assessment of acute kidney injury (AKI) in septic patients remains imprecise. In adults, the classification of septic patients by clinical AKI phenotypes (severity and timing) demonstrates unique associations with patient outcome vs. broadly defined AKI. Methods In a multinational prospective observational study, AKI diagnosis in critically ill septic children was stratified by duration (transient vs. persistent) and severity (mild vs. severe by creatinine change and urine output). The outcomes of interest were mortality and intensive care unit resource complexity at 28 days. Results Seven hundred and fifty-seven septic children were studied (male 52.7%, age 4.6 years (1.5–11.9)). Mortality (overall 12.1%) was different between severe AKI and mild AKI (18.3 vs. 4.4%, p < 0.001) as well as intensive care unit (ICU) complexity (overall 34.5%, 45 vs. 21.7%, p < 0.001). Patients with Persistent AKI had fewer ICU-free days (17 (7, 21) vs. 24 (17, 26), p < 0.001) and higher ICU complexity (52.8 vs. 22.9%, p = 0.002) than transient AKI, even after exclusion of patients with early mortality. AKI phenotypes incorporating temporal and severity data correlate with unique survival (range 4.4–21.6%) and ICU-free days (range of 15–25 days) Conclusions The outcome of septic children with AKI changes by clinical phenotype. Our findings underscore the importance of prognostic enrichment in sepsis and AKI for the purpose of trial design and patient management. Impact Although AKI occurs commonly in patients with sepsis (S-AKI), outcomes for children with S-AKI varies based on the severity and timing of the AKI. Existing S-AKI pediatric data utilize a broad singular definition of kidney injury. Increasing the precision of AKI classification results in a new understanding of how S-AKI associates with patient outcome. A refined classification of S-AKI identifies subgroups of children, making possible a targeted and a personalized medicine approach to S-AKI study and management.

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Consensus-Based Recommendations on Priority Activities to Address Acute Kidney Injury in Children

et al. 2022

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ImportanceIncreasing evidence indicates that acute kidney injury (AKI) occurs frequently in children and young adults and is associated with poor short-term and long-term outcomes. Guidance is required to focus efforts related to expansion of pediatric AKI knowledge.ObjectiveTo develop expert-driven pediatric specific recommendations on needed AKI research, education, practice, and advocacy.Evidence ReviewAt the 26th Acute Disease Quality Initiative meeting conducted in November 2021 by 47 multiprofessional international experts in general pediatrics, nephrology, and critical care, the panel focused on 6 areas: (1) epidemiology; (2) diagnostics; (3) fluid overload; (4) kidney support therapies; (5) biology, pharmacology, and nutrition; and (6) education and advocacy. An objective scientific review and distillation of literature through September 2021 was performed of (1) epidemiology, (2) risk assessment and diagnosis, (3) fluid assessment, (4) kidney support and extracorporeal therapies, (5) pathobiology, nutrition, and pharmacology, and (6) education and advocacy. Using an established modified Delphi process based on existing data, workgroups derived consensus statements with recommendations.FindingsThe meeting developed 12 consensus statements and 29 research recommendations. Principal suggestions were to address gaps of knowledge by including data from varying socioeconomic groups, broadening definition of AKI phenotypes, adjudicating fluid balance by disease severity, integrating biopathology of child growth and development, and partnering with families and communities in AKI advocacy.Conclusions and RelevanceExisting evidence across observational study supports further efforts to increase knowledge related to AKI in childhood. Significant gaps of knowledge may be addressed by focused efforts.

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Acute Kidney Injury in Critically Ill Children and Subsequent Chronic Kidney Disease

Cited by 55 publications

References 41 publications

Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years

Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years

Clinical phenotypes of acute kidney injury are associated with unique outcomes in critically ill septic children

Consensus-Based Recommendations on Priority Activities to Address Acute Kidney Injury in Children

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