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Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study


, : Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. American Journal of Kidney Diseases 59(4): 523-530

The development of standardized acute kidney injury (AKI) definitions has allowed for a better understanding of AKI epidemiology, but the long-term renal outcomes of AKI in the pediatric critical care setting have not been well established. This study was designed to: (1) determine the incidence of chronic kidney disease (CKD) in children 1-3 years after an episode of AKI at a tertiary-care pediatric intensive care unit (ICU), identify the proportion of patients at risk of CKD, and compare ICU admission characteristics in those with and without CKD. Prospective cohort study. & ParticipantsPatients admitted to the British Columbia Children's Hospital pediatric ICU from 26-28 with AKI, as defined by AKI Network (AKIN) criteria. Surviving patients, most with short-term recovery from their AKI, were assessed at 1, 2, or 3 years after AKI.PredictorsSeverity of AKI as defined by AKIN and several ICU admission characteristics, including demographics, diagnosis, severity of illness, and ventilation data.Outcomes & MeasurementsCKD was defined as the presence of albuminuria and/or glomerular filtration rate (GFR) <6 mL/min/1.73 m. Being at risk of CKD was defined as having a mildly decreased GFR (6-9 mL/min/1.73 m), hypertension, and/or hyperfiltration (GFR ?15 mL/min/1.73 m). The proportion of patients with AKI stages 1, 2, and 3 were 44 of 126 (35%), 47 of 126 (37%), and 35 of 126 (28%), respectively. The number of patients with CKD 1-3 years after AKI was 13 of 126 (1.3% overall; 2 of 44 [4.5%] with stage 1, 5 of 47 [1.6%] with stage 2, and 6 of 35 [17.1%] with stage 3;P= .2). In addition, 59 of 126 (46.8%) patients were identified as being at risk of CKD.LimitationsSeveral patients identified with AKI were lost to follow-up, with the potential of underestimating the incidence of CKD. In tertiary-care pediatric ICU patients, ?1% develop CKD 1-3 years after AKI. The burden of CKD in this population may be higher with further follow-up because several patients were identified as being at risk of CKD. Regardless of the severity of AKI, all pediatric ICU patients should be monitored regularly for long-term kidney damage.

US$19.90

PMID: 22206744

DOI: 10.1053/j.ajkd.2011.10.048


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