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Published on: February 2, 2021
Consensus-Based Recommendations on Priority Activities to Address Acute Kidney Injury in Children: A Modified Delphi
Stuart L Goldstein1, Ayse Akcan-Arikan2, Rashid Alobaidi3
1Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Acute kidney injury (AKI) affects many children and young adults, necessitating focused research and improved care. This study provides expert recommendations to advance pediatric AKI knowledge and outcomes.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Public Health
Background:
- Acute kidney injury (AKI) is increasingly recognized in pediatric and young adult populations.
- AKI in children is linked to adverse short-term and long-term health consequences.
- There is a critical need for enhanced knowledge and focused efforts in pediatric AKI.
Purpose of the Study:
- To establish expert-driven, pediatric-specific recommendations for AKI research.
- To guide improvements in pediatric AKI education, clinical practice, and advocacy.
- To address knowledge gaps and improve outcomes for children with AKI.
Main Methods:
- Convened 47 international experts in pediatrics, nephrology, and critical care for the 26th Acute Disease Quality Initiative meeting.
- Conducted a comprehensive review of literature up to September 2021 across six key AKI domains.
- Utilized a modified Delphi process to derive consensus statements and research recommendations.
Main Results:
- Generated 12 consensus statements and 29 research recommendations for pediatric AKI.
- Highlighted the need for research including diverse socioeconomic groups and broader AKI phenotype definitions.
- Recommended improved fluid balance assessment, integration of growth/developmental biopathology, and family/community partnerships in advocacy.
Conclusions:
- Observational evidence underscores the importance of further research in childhood AKI.
- Focused research efforts are essential to address significant knowledge gaps in pediatric AKI.
- These recommendations provide a roadmap for advancing pediatric AKI care and research.
Importance:
Increasing evidence indicates that acute kidney injury (AKI) occurs frequently in children and young adults and is associated with poor short-term and long-term outcomes. Guidance is required to focus efforts related to expansion of pediatric AKI knowledge.
Objective:
To develop expert-driven pediatric specific recommendations on needed AKI research, education, practice, and advocacy.
Evidence Review:
At the 26th Acute Disease Quality Initiative meeting conducted in November 2021 by 47 multiprofessional international experts in general pediatrics, nephrology, and critical care, the panel focused on 6 areas: (1) epidemiology; (2) diagnostics; (3) fluid overload; (4) kidney support therapies; (5) biology, pharmacology, and nutrition; and (6) education and advocacy. An objective scientific review and distillation of literature through September 2021 was performed of (1) epidemiology, (2) risk assessment and diagnosis, (3) fluid assessment, (4) kidney support and extracorporeal therapies, (5) pathobiology, nutrition, and pharmacology, and (6) education and advocacy. Using an established modified Delphi process based on existing data, workgroups derived consensus statements with recommendations.
Findings:
The meeting developed 12 consensus statements and 29 research recommendations. Principal suggestions were to address gaps of knowledge by including data from varying socioeconomic groups, broadening definition of AKI phenotypes, adjudicating fluid balance by disease severity, integrating biopathology of child growth and development, and partnering with families and communities in AKI advocacy.
Conclusions And Relevance:
Existing evidence across observational study supports further efforts to increase knowledge related to AKI in childhood. Significant gaps of knowledge may be addressed by focused efforts.
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