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Long-term Mortality After Acute Kidney Injury in the Pediatric ICU
Erin Hessey1, Geneviève Morissette2, Jacques Lacroix3
1Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada.
Insights
Pediatric patients who experience acute kidney injury (AKI) in the pediatric intensive care unit (PICU) face increased long-term mortality risk. This study confirms AKI is a significant predictor of death years after discharge.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Epidemiology
Background:
- Acute kidney injury (AKI) is a common complication in pediatric intensive care units (PICUs).
- The long-term consequences of AKI in children, particularly after noncardiac surgery, require further investigation.
- Understanding the association between AKI and mortality is crucial for patient management and follow-up.
Purpose of the Study:
- To evaluate the association between acute kidney injury (AKI) in the PICU and long-term mortality in pediatric patients.
- To determine if adding urine output (UO)-defined AKI criteria modifies the association between AKI and mortality.
Main Methods:
- A retrospective cohort study included 2041 children (≤18 years) admitted to the PICU for noncardiac surgery (2003-2005), with follow-up until 2010.
- AKI was defined using serum creatinine and/or urine output (UO) criteria.
- Cox regression analysis assessed the association between AKI and long-term mortality, ascertained through administrative data.
Main Results:
- AKI was independently associated with increased 5- to 7-year mortality post-discharge (aHR: 3.10-3.38).
- Of 2041 hospital survivors, 5.8% died within 5 to 7 years.
- Inclusion of UO criteria did not significantly alter the observed association between AKI and mortality.
Conclusions:
- Pediatric acute kidney injury (AKI) is significantly associated with increased long-term mortality.
- Patients with AKI in the PICU represent a high-risk group requiring consideration for targeted follow-up.
- Further research is needed to elucidate the causal relationship between AKI and mortality in this population.
Objectives:
(1) To evaluate the association between acute kidney injury (AKI) in the PICU and long-term mortality and (2) to determine the extent to which adding the urine output (UO)-defined AKI alters the association.
Methods:
A 2-center retrospective cohort study of children (≤18 years old) admitted to the PICU between 2003 and 2005 for noncardiac surgery, with follow-up until 2010. Patients with end stage renal disease, no provincial health insurance number, who died during hospitalization, or could not be linked to administrative data were excluded. One hospitalization per patient was included. AKI was defined by using serum creatinine criteria and/or UO criteria. Mortality was ascertained by using administrative data. Cox regression analysis was performed to evaluate the association between AKI and long-term mortality.
Results:
The study population included 2041 patients (55.7% male, mean admission age 6.5 ± 5.8 years). Of 2041 hospital survivors, 9 (0.4%) died within 30 days, 51 (2.5%) died within 1 year, and 118 (5.8%) died within 5 to 7 years postdischarge. AKI was independently associated with 5- to 7-year mortality (adjusted hazard ratio [95% confidence interval]: 3.10 [1.46-6.57] and 3.38 [1.63-7.02], respectively). Including UO did not strengthen the association.
Conclusions:
AKI is associated with 5- to 7-year mortality. Because this is an observational study we cannot determine if AKI is causative of mortality or of the pathophysiology. However, patients with AKI represent a high-risk group. It is reasonable that these patients be considered for targeted follow-up until future researchers better elucidate these relationships.
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