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Acute kidney injury in critically ill children and 5-year hypertension
Erin Hessey1,2, Sylvie Perreault3, Louise Roy4
1Department of Pediatrics, Division of Nephrology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Québec, Canada.
Insights
Pediatric intensive care unit (ICU) survivors with acute kidney injury (AKI) face a doubled risk of developing hypertension within five years post-discharge. This study highlights the long-term cardiovascular risks associated with AKI in children, emphasizing the need for vigilant hypertension screening.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Cardiovascular Epidemiology
Background:
- Hypertension is a significant concern in pediatric populations.
- Acute kidney injury (AKI) is a common complication in pediatric intensive care units (ICUs).
- Long-term outcomes, including hypertension, following pediatric ICU stays are not fully understood.
Purpose of the Study:
- To develop and validate a pediatric-specific hypertension algorithm using administrative data.
- To assess the association between pediatric ICU-acquired AKI and the subsequent diagnosis of hypertension 5 years post-discharge.
Main Methods:
- A retrospective cohort study included children (≤18 years) admitted to a pediatric ICU in Montreal (2003-2005), followed until 2010.
- Exclusion criteria included end-stage renal disease, cardiac surgery, pre-existing renal disease with hypertension, or prior hypertension diagnosis.
- AKI was defined using KDIGO criteria; hypertension was identified using administrative data (diagnostic codes and medications).
Main Results:
- The study analyzed 1,978 pediatric ICU patients; 16.4% developed AKI.
- A hypertension diagnosis occurred in 7% of patients 5 years post-discharge.
- Patients with AKI showed a significantly higher prevalence of hypertension (14.2% vs. 5.1%, p < .001) and a 2.19-fold increased adjusted risk.
Conclusions:
- Pediatric ICU survivors exhibit a high prevalence of post-discharge hypertension.
- Children who experience AKI during their ICU stay have more than double the risk of developing hypertension compared to those without AKI.
- These findings underscore the critical importance of long-term cardiovascular monitoring for pediatric AKI survivors.
Background:
To develop a pediatric-specific hypertension algorithm using administrative data and use it to evaluate the association between acute kidney injury (AKI) in the intensive care unit (ICU) and hypertension diagnosis 5 years post-discharge.
Methods:
Two-center retrospective cohort study of children (≤ 18 years old) admitted to the pediatric ICU in Montreal, Canada, between 2003 and 2005 and followed until 2010. Patients with a valid healthcare number and without end-stage renal disease were included. Patients who could not be merged with the provincial database, did not survive admission, underwent cardiac surgery, had pre-existing renal disease associated with hypertension or a prior diagnosis of hypertension were excluded. AKI defined using the Kidney Disease: Improving Global Outcomes (KDIGO) definition. Using diagnostic codes and medications from administrative data, novel pediatric-specific hypertension definitions were designed. Both the evaluation of the prevalence of hypertension diagnosis and the association between AKI and hypertension occurred.
Results:
Nineteen hundred and seventy eight patients were included (median age at admission [interquartile range] 4.3 years [1.1-11.8], 44% female, 325 (16.4%) developed AKI). Of these patients, 130 (7%) had a hypertension diagnosis 5 years after discharge. Patients with AKI had a higher prevalence of hypertension diagnosis [non-AKI: 84/1653 (5.1%) vs. AKI: 46/325 (14.2%), p < .001]. Children with AKI had a higher adjusted risk of hypertension diagnosis (hazard ratio [95% confidence interval] 2.19 [1.47-3.26]).
Conclusions:
Children admitted to the ICU have a high prevalence of hypertension post-discharge and children with AKI have over two times higher risk of hypertension compared to those with no AKI.
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