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Risk factors and occurrence of chronic kidney disease following acute kidney injury in Children
Muzafar Jan1, Mohd Ashraf1, Ruhail Ahmad Baba1
1Department of Pediatrics and Pediatric Nephrology, Government Medical College, Srinagar, Jammu and Kashmir, India.
Insights
Acute kidney injury (AKI) can lead to chronic kidney disease (CKD) in children. Monitoring blood pressure and proteinuria after discharge is crucial for identifying at-risk patients.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Public Health
Background:
- Acute kidney injury (AKI) is an increasingly recognized cause of chronic kidney disease (CKD).
- Understanding the long-term sequelae of AKI in pediatric populations is essential.
Purpose of the Study:
- To investigate the incidence of CKD following AKI in pediatric intensive care unit (PICU) patients.
- To identify risk factors and long-term outcomes associated with AKI in children.
Main Methods:
- Prospective observational study of 119 pediatric patients in a tertiary care hospital.
- AKI defined by serum creatinine, urine output criteria; 1-year follow-up post-discharge.
- Analysis of mortality, hypertension, and proteinuria as CKD progression markers.
Main Results:
- 5.6% of pediatric AKI patients developed CKD within 1 year.
- AKI-associated PICU mortality was 13.4%.
- Elevated blood pressure and proteinuria at discharge and 3-month follow-up significantly predicted CKD progression.
Conclusions:
- CKD following AKI is a significant concern in pediatric patients.
- Long-term monitoring for hypertension and proteinuria is vital for post-AKI patients.
- The risk of CKD after AKI may be underestimated; vigilant follow-up is recommended.
Background:
Chronic kidney disease (CKD) is an irreversible progressive condition with diverse etiologies among which acute kidney injury (AKI) is increasingly being recognized as an important one.
Methods:
This was a prospective observational study of pediatric intensive care unit (PICU) patients admitted with different etiologies, at a tertiary care hospital for children in Kashmir India, between October 2018 and September 2020. AKI was defined as an increase in absolute serum creatinine (SCr) ≥0.3 mg/dL or by a percentage increase in SCr 50% and/or by a decrease in urine output to <0.5 mL/kg/h for >6 hours (h). Besides analysis of AKI and associated PICU mortality, post-AKI patients after discharge were kept on follow-up for complete 1 year.
Results:
From 119 enrolled patients with AKI with no preexisting risk factors, 5.6% (n = 8/119) developed CKD. The AKI-associated mortality rate after 48 h of PICU stay was 13.4% (n = 16/119). At time of discharge from hospital, elevated blood pressure (BP) (n = 5/8) and subnephrotic proteinuria (n = 3/8) were the statistically significant sequels of AKI (P value <0.001) for progression to CKD. After 3 months of follow-up, elevated BP (n = 7/8) and subnephrotic proteinuria (n = 3/8) were significantly associated with progression to CKD at 1 year (P < 0.005).
Conclusions:
Occurrence of CKD after an attack of AKI was not uncommon and the risk of long-term consequences in the form of hypertension, proteinuria, and CKD is significant, which may be much higher than observed. It is prudent that all post-AKI PICU discharged patients must be monitored for the long-term consequences of AKI.
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