Original Investigation
Pathogenesis and Treatment of Kidney Disease
Long-term Risk of CKD in Children Surviving Episodes of Acute Kidney Injury in the Intensive Care Unit: A Prospective Cohort Study

https://doi.org/10.1053/j.ajkd.2011.10.048Get rights and content

Background

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), (2) identify the proportion of patients at risk of CKD, and (3) compare ICU admission characteristics in those with and without CKD.

Setting & Participants

Patients admitted to the British Columbia Children's Hospital pediatric ICU from 2006-2008 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.

Predictors

Severity of AKI as defined by AKIN and several ICU admission characteristics, including demographics, diagnosis, severity of illness, and ventilation data.

Outcomes & Measurements

CKD was defined as the presence of albuminuria and/or glomerular filtration rate (GFR) <60 mL/min/1.73 m2. Being at risk of CKD was defined as having a mildly decreased GFR (60-90 mL/min/1.73 m2), hypertension, and/or hyperfiltration (GFR ≥150 mL/min/1.73 m2).

Results

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 (10.3% overall; 2 of 44 [4.5%] with stage 1, 5 of 47 [10.6%] with stage 2, and 6 of 35 [17.1%] with stage 3; P = 0.2). In addition, 59 of 126 (46.8%) patients were identified as being at risk of CKD.

Limitations

Several patients identified with AKI were lost to follow-up, with the potential of underestimating the incidence of CKD.

Conclusions

In tertiary-care pediatric ICU patients, ∼10% 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.

Section snippets

Setting, Design, and Participants

We performed a prospective cohort study of patients surviving an episode of AKI in the pediatric ICU at British Columbia Children's Hospital (Vancouver, Canada) from January 2006 to December 2008. The University of British Columbia Ethics Review Board approved the study protocol, and parents/legal guardians provided informed consent before formal enrollment.

Potential study patients were identified through a pediatric ICU admission electronic database. Except for one patient who became dialysis

Patient Characteristics

Baseline ICU admission characteristics for all patients with AKI seen in follow-up (n = 126) compared with those lost to follow-up (n = 173), including demographics, primary diagnoses, ventilation data, measures of illness severity (Pediatric Risk of Mortality [PRISM] III score), and maximal AKIN stage achieved, are listed in Table S1 (available as online supplementary material). Overall, there were no major differences in ICU admission characteristics between these 2 groups except for a

Discussion

The development of standardized AKI definitions has allowed for a more complete understanding of pediatric AKI epidemiology, but the long-term renal outcomes of AKI in critically ill children and neonates have not been well established. Several recent adult studies have shown that those who survive an episode of AKI are at considerable risk of progressing to CKD.30, 31, 32, 33, 34 In prior follow-up studies of pediatric AKI, the incidence of CKD ranges from 27%-66.7%.35, 36, 37, 38, 39, 40, 41

Acknowledgements

An abstract of this study was presented at the American Society of Nephrology (ASN) 43rd Annual Meeting and Scientific Exposition in Denver, CO (November 20, 2010).

Support: This work was supported through the research fellowship training of C.M. (Clinician Investigator Program, University of British Columbia).

Financial Disclosure: The authors declare that they have no other relevant financial interests.

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    Originally published online December 30, 2011.

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