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Acute Kidney Disease following Acute Kidney Injury in Children-A Retrospective Observational Cohort Study on Risk
Flavia Chisavu1,2, Lazar Chisavu2,3, Viviana Ivan2,4
1Department of Paediatric Nephrology, "Louis Turcanu" Emergency County Hospital for Children, Rue Iosif Nemoianu, Number 2, 300041 Timisoara, Romania.
Insights
In children with acute kidney injury (AKI), anemia and specific intrinsic kidney conditions like glomerulonephritis increase the risk of developing acute kidney disease (AKD). AKD significantly raises mortality and the likelihood of developing chronic kidney disease (CKD).
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Epidemiology
Background:
- Acute kidney disease (AKD) is linked to higher mortality and progression to chronic kidney disease (CKD) in adults, but data in children are limited.
- Understanding AKD risk factors in pediatric acute kidney injury (AKI) is crucial for improving outcomes.
Purpose of the Study:
- To identify risk factors for AKD development in children with AKI, considering biological parameters, exposures, and susceptibilities.
- To analyze the trajectory of AKD post-AKI, focusing on mortality and progression to new-onset CKD.
Main Methods:
- Retrospective evaluation of 736 children (ages 2-18) with AKI over a 9-year period in a tertiary care hospital.
- Analysis of patient data including biological parameters, AKI causes, and clinical outcomes (mortality, CKD development).
Main Results:
- AKD developed in 17% of pediatric AKI patients.
- Anemia independently increased AKD risk (2.47 times). Intrinsic AKI causes, specifically glomerulonephritis (4.94 times) and acute tubule-interstitial nephritis (2.76 times), also elevated AKD risk.
- AKD independently increased overall mortality (2.6 times) and was a risk factor for new-onset CKD.
Conclusions:
- Anemia, glomerulonephritis, and acute tubule-interstitial nephritis are key risk factors for AKD development in children with AKI.
- AKD is an independent predictor of mortality and progression to CKD in the pediatric population.
Abstract:
Background: Acute kidney disease (AKD) is a known risk factor for increased mortality and evolution towards chronic kidney disease (CKD) in adults. The data regarding AKD in children are scarce. The purpose of our study was to explore the risk factors for developing AKD based on exposures and susceptibilities in children with AKI doubled by the biological parameters from the first day of identified AKI. In addition, we followed the trajectory of AKD following an acute kidney injury (AKI) episode in children during hospital admission and after discharge with special considerations towards mortality and progression to new-onset CKD. Methods: We retrospectively evaluated 736 children, ages between 2 and 18 years old, with identified AKI during hospital admission in a tertiary care hospital from west Romania over a 9-year period. Results: AKD incidence following an AKI episode was 17%. Patients who developed AKD were older, with higher baseline serum creatinine, urea, C reactive protein and lower proteins, haemoglobin and sodium levels. In the adjusted model, no biological parameters influenced AKD development. Regarding certain exposures and personal susceptibilities in children with AKI, only anaemia independently increased the risk of AKD development by 2.47 times. However, out of the AKI causes, only the intrinsic causes of AKI independently increased the risk of progressing to AKD (glomerulonephritis by 4.94 and acute tubule-interstitial nephritis by 2.76 times). AKD increased the overall mortality by 2.6 times. The factors that independently increased the risk of CKD were AKD, acute tubular necrosis and higher baseline serum creatinine values. Conclusions: Only anaemia, glomerulonephritis and acute tubule-interstitial nephritis increased the risk of AKD development in children with AKI. AKD was an independent risk factor for mortality and new-onset CKD in children.
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