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Published on: July 17, 2016
Acute Kidney Injury in Critically Ill Children and Subsequent Chronic Kidney Disease
Erin Hessey1, Sylvie Perreault2, Marc Dorais3
1Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, QC, Canada.
Insights
Pediatric acute kidney injury (AKI) increases the risk of developing chronic kidney disease (CKD) within five years. This study highlights the long-term impact of AKI on children's kidney health.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Epidemiology
Background:
- The transition from acute kidney injury (AKI) to chronic kidney disease (CKD) in pediatric populations remains poorly understood.
- Identifying risk factors for CKD development after critical illness in children is crucial for early intervention.
Purpose of the Study:
- To establish a definition for pediatric CKD using administrative data.
- To investigate the association between AKI in critically ill children and the subsequent development of CKD five years post-hospital discharge.
Main Methods:
- A retrospective cohort study was conducted using chart and administrative data from two Montreal pediatric intensive care units (PICUs).
- Children aged 18 years or younger admitted between 2003-2005, excluding those with end-stage renal disease or pre-existing kidney conditions, were included.
- AKI was defined by KDIGO criteria, and CKD was identified by diagnostic codes or medication prescriptions five years post-discharge.
Main Results:
- The study included 2235 children, with 21% experiencing AKI during their PICU stay.
- At five years post-discharge, 2% of patients received a CKD diagnosis.
- Both stage 1 and stage 2-3 AKI were associated with a significantly increased risk of CKD diagnosis (aHRs 2.2 and 2.5, respectively).
Conclusions:
- Pediatric acute kidney injury is a significant risk factor for developing chronic kidney disease within five years.
- Administrative health care data can be utilized to define and track pediatric CKD outcomes.
- Further research is needed to explore post-discharge variables that may influence CKD development.
Background:
The progression from acute kidney injury (AKI) to chronic kidney disease (CKD) is not well understood in children.
Objectives:
We aimed to develop a pediatric CKD definition using administrative data and use it to evaluate the association between AKI in critically ill children and CKD 5 years after hospital discharge.
Design:
Retrospective cohort study using chart collection and administrative data.
Setting:
Two-center study in Montreal, Canada.
Patients:
Children (≤18 years old) admitted to two pediatric intensive care units (ICUs) between 2003 and 2005. We a priori excluded patients with end-stage renal disease or no health care number. Only the first admission during the study period was included. We excluded patients who could not be linked to administrative data, did not survive hospitalization, or had preexisting renal disease.
Measurements:
Acute kidney injury was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patients were defined as having CKD 5 years post-discharge if they had ≥1 CKD diagnostic code or ≥1 CKD-specific medication prescription.
Methods:
Chart data used to define the exposure (AKI) were merged with provincial administrative data used to define the outcome (CKD). Cox regression was used to evaluate the AKI-CKD association.
Results:
A total of 2235 (56% male) patients were included, and the median admission age was 3.7 years. A total of 464 (21%) patients developed AKI during pediatric ICU admission. At 5 years post-discharge, 43 (2%) patients had a CKD diagnosis. Patients with both stage 1 and stage 2-3 AKI had increased risk of a CKD diagnosis, with the adjusted hazard ratios (95% confidence intervals) of 2.2 (1.1-4.5) and 2.5 (1.1-5.7), respectively (P < .001).
Limitations:
Results may not be generalizable to non-ICU patients. We were not able to control for post-discharge variables; future research should try to explore these additional potential risk factors further.
Conclusions:
Acute kidney injury is associated with 5-year post-discharge CKD diagnosis defined by administrative health care data.
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