Long-term Mortality After Acute Kidney Injury in the Pediatric ICU

Hessey, Erin; Morissette, Geneviève; Lacroix, Jacques; Perreault, Sylvie; Samuel, Susan; Dorais, Marc; Jouvet, Philippe; Lafrance, Jean‐Philippe; LeLorier, Jacques; Phan, Véronique; Palijan, Ana; Pizzi, Michael; Roy, Louise; Zappitelli, Michael

doi:10.1542/hpeds.2017-0215

Cited by 43 publications

(44 citation statements)

References 37 publications

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“…21 In noncardiac surgery children admitted to the intensive care unit, AKI has been shown to be associated with increased health care use, including postdischarge hospitalizations, physician visits, and other important health outcomes. 8,22,23 Therefore, given the known strong association of AKI with readmission and other outcomes in non-cardiac surgery populations, these findings are notable. Children undergoing cardiac surgery are at high risk of readmission, which prompts an urgent need to find easily identifiable, strong predictors that would allow for targeted interventions to reduce readmission.…”

Section: Discussionmentioning

confidence: 91%

The association of acute kidney injury with hospital readmission and death after pediatric cardiac surgery

et al. 2020

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Background: Acute kidney injury (AKI) in children undergoing cardiac surgery (CS) is strongly associated with increased hospital mortality and length of stay. The association of AKI with postdischarge outcomes is unclear. We evaluated the association of AKI with all-cause readmissions and death within 30 days and 1 year of CS discharge. Methods: This was a prospective, 3-center cohort study of children after CS with cardiopulmonary bypass. The primary exposures were postoperative stage 1 AKI and stage 2 AKI defined by Kidney Disease: Improving Global Outcomes AKI definition. Two separate outcomes were hospital readmission and death within 30 days and 1 year of discharge. Association of AKI with time to outcomes was determined using multivariable Cox-proportional hazards analysis. Age, The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery risk adjustment tool score 3, cardiopulmonary bypass >120 minutes, and cyanotic heart disease were evaluated as effect modifiers. PERSPECTIVE Reducing postoperative readmission and death is a priority. This is the first prospective cohort study to evaluate the relationship between AKI and post-cardiac surgery discharge readmission in children. Identifying risk factors for readmission and death may enable targeted follow up of atrisk groups and potentially decrease long-term morbidity and mortality. See Commentaries on pages 86 and 88.

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Section: Discussionmentioning

confidence: 91%

The association of acute kidney injury with hospital readmission and death after pediatric cardiac surgery

et al. 2020

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“…The longest follow-up study looked at mortality 5-7 years after hospital discharge in a non-cardiac surgery PICU population and found that AKI was associated with over 3 times higher risk of mortality (17). Interestingly, this paper demonstrated that the association between AKI and 30-day and 1-year mortality was conditional on the inclusion of hospital mortality in the outcome.…”

Section: General Picu Populationmentioning

confidence: 89%

“…Previous studies evaluating short-and long-term mortality following AKI lacked non-AKI comparison groups, however, they uniformly highlight that mortality rates in patients with AKI were higher than in the general population (12,13). Since 2015, we identified eight studies that examined the association of AKI with mortality and compared this to children who did not develop AKI, with follow-up ranging from 28-days to 5-7 years (Table 1) (3,6,(14)(15)(16)(17)(18)(19). As highlighted in Table 1, despite differences in study populations and duration of followup, all studies reported higher mortality in those with AKI when compared with children who did not experience AKI whilst in the PICU, independent of illness severity and other important confounders.…”

Section: Mortalitymentioning

confidence: 99%

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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“…Anak berbeda dengan dewasa, maka perhitungan dosis berdasarkan berat badan anak. Beberapa kasus CKD yang diperlukan penyesuaian dosis dengan klirens kreatinin atau laju filtrasi glomerulus [26]. Kesalahan dalam penyesuaian dosis obat dapat menyebabkan efek samping toksisitas, hasil terapi buruk, sehingga biaya pengobatan bertambah dan peningkatan lama rawat inap [27].…”

Section: Hasil Dan Diskusiunclassified

Evaluasi Penggunaan Antibiotik Secara Kualitatif dan Analisis Efektivitas Biaya pada Pasien Pediatri di RSUP Fatmawati Jakarta

2019

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Peresepan antibiotika yang tidak tepat akan meningkatkan kejadian resistensi. Resistensi antimikroba telah menjadi masalah kesehatan yang mendunia dengan dampak meningkatkan morbiditas, mortalitas, dan biaya kesehatan. Penelitian ini bertujuan untuk mengetahui kualitas penggunaan antibiotik pada pasien pediatri dan pengaruh rekomedasi apoteker dalam meningkatkan kualitas penggunaan antibiotik, menurunkan lama rawat, serta biaya pengobatan. Penelitian ini menggunakan studi pra eksperimen dengan pendekatan prospektif. Data penelitian dikumpulkan dari rekam medik pasien dan dianalis dengan uji chi square serta uji korelasi. Hasil penelitian menunjukkan bahwa rekomendasi apoteker dapat menurunkan masalah ketidaktepatan dosis (29,73%) menjadi 0%), ketidaktepatan lama pemberian (51,35% menjadi 5,41%), dan ketidaktepatan pemilihan obat (18,92% menjadi 5,41%). Average Cost Effectiveness Ratio (ACER) terhadap lama rawat kelompok rekomendasi (R) adalah Rp 2.481.456 lebih rendah dibandingkan kelompok non rekomendasi (NR) adalah Rp 2.640.703, sedangkan ACER terhadap hasil terapi (sembuh) kelompok rekomendasi (R) Rp 9.369.404 lebih rendah dibandingkan kelompok non rekomendasi (NR) Rp 17.985.054. Berdasarkan hasil penelitian dapat disimpulkan bahwa penggunaan antibiotik di RSUP Fatmawati tepat dan bijak, rekomendasi apoteker dapat meningkatkan kualitas penggunaan antibiotik, menurunkan lama rawat dan biaya pengobatan.

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Long-term Mortality After Acute Kidney Injury in the Pediatric ICU

Cited by 43 publications

References 37 publications

The association of acute kidney injury with hospital readmission and death after pediatric cardiac surgery

The association of acute kidney injury with hospital readmission and death after pediatric cardiac surgery

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

Evaluasi Penggunaan Antibiotik Secara Kualitatif dan Analisis Efektivitas Biaya pada Pasien Pediatri di RSUP Fatmawati Jakarta

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