Related Experiment Video
Updated: Sep 23, 2025
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Long-term kidney outcomes in children following continuous kidney replacement therapy
Jeanne Frisby-Zedan1,2, Matthew F Barhight3,4, Mahima Keswani3,4
1Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL, 60611, USA. jfrisbyzedan@luriechildrens.org.
Insights
Critically ill children treated with continuous kidney replacement therapy (CKRT) face a significant risk of developing chronic kidney disease (CKD). Follow-up care with pediatric nephrologists is often insufficient for these high-risk patients.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Continuous kidney replacement therapy (CKRT) is crucial for managing severe acute kidney injury (AKI) in critically ill children.
- Limited data exists regarding the long-term risk of chronic kidney disease (CKD) in this pediatric population post-discharge.
Purpose of the Study:
- To assess the incidence of and risk factors for kidney sequelae in pediatric patients after CKRT.
- To evaluate the follow-up care provided by pediatric nephrologists to these high-risk patients.
Main Methods:
- A single-center, retrospective cohort study included pediatric patients (0-17 years) who received CKRT between 2013 and 2017.
- Patients with pre-existing CKD, those who died before discharge, or with insufficient follow-up data were excluded.
- Electronic health records were analyzed for kidney sequelae incidence and risk factors post-hospital discharge.
Main Results:
- Of 42 patients followed for a median of 27 months, 26.2% showed evidence of CKD and 19% were at risk for CKD.
- Lower estimated glomerular filtration rate (eGFR) at discharge was linked to increased odds of kidney sequelae (aOR 0.985).
- Younger (0-<1 year) and older (12-17 years) age groups had the highest incidence of kidney sequelae, while ages 1-5 and 6-11 showed decreased odds.
Conclusions:
- Pediatric patients treated with CKRT for AKI have a substantial risk of developing CKD.
- Follow-up care with pediatric nephrologists for these high-risk patients is suboptimal.
- The study highlights the need for improved monitoring and management of kidney health in children post-CKRT.
Background:
Continuous kidney replacement therapy (CKRT) is a mainstay of therapy for management of severe acute kidney injury (AKI) in critically ill pediatric patients. There is limited data on the risk of chronic kidney disease (CKD) after discharge in this population.
Methods:
This is a single-center, retrospective cohort study of all pediatric patients ages 0-17 years who received CKRT from 2013 to 2017. The study excluded patients with pre-existing CKD, those who died prior to discharge, and those who had insufficient follow-up data. Patients were followed after hospital discharge and electronic health record data was collected and analyzed to assess for incidence of and risk factors for kidney sequelae.
Results:
A total of 42 patients were followed at a median time of 27 months (IQR 17.2, 39.8). Of these, 26.2% had evidence of CKD and 19% were at risk for CKD. Lower eGFR at hospital discharge was associated with increased odds of kidney sequelae (aOR 0.985; 95% CI 0.972, 0.996). Ages 0- < 1 and 12-17 were not significantly different (aOR 0.235, 95% CI 0.024, 1.718) and had the highest incidence of kidney sequelae (50% and 77%, respectively). Ages 1-5 and 6-11 had a decreased odds of kidney sequelae compared to the 12-17 year age group (aOR 0.098; 95% CI 0.009, 0.703 and aOR 0.035; 95% CI 0.001, 0.39, respectively). Only 54.8% of patients (n = 23) were seen in the nephrology clinic after discharge.
Conclusions:
Patients who receive CKRT for AKI have a significant risk of CKD, while follow-up with a pediatric nephrologist in these high-risk patients is sub-optimal. A higher resolution version of the Graphical abstract is available as Supplementary information.
More Related Videos
Related Concept Videos
01:29Acute Kidney Injury III: Clinical Manifestations
01:30Continuous Renal Replacement Therapy
01:26Kidney Transplant II: Surgical Procedure
01:28Kidney Transplant I: Introduction
01:16Kidney Transplant III: Nursing Management
01:28Chronic Kidney Disease III: Interprofessional Care