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Outcomes of acute kidney injury continuum in children
Flavia Chisavu1,2,3, Mihai Gafencu4,5, Ramona Stroescu1,2
1University of Medicine and Pharmacy 'Victor Babes' from Timisoara, Eftimie Murgu, rue nr. 2, Timisoara, Romania.
Insights
Acute kidney injury (AKI) progression to acute kidney disease increases mortality risk in children. Intrinsic causes, not severity, influence the risk of new-onset chronic kidney disease (CKD) after AKI.
Area of Science:
- Pediatric Nephrology
- Renal Medicine
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) is a significant health concern in children, associated with high morbidity and mortality.
- The long-term consequences of AKI, particularly the progression of kidney damage, are not well understood in the pediatric population.
Purpose of the Study:
- To investigate the impact of acute kidney injury duration on mortality in children.
- To evaluate the association between AKI progression and the risk of developing new-onset chronic kidney disease (CKD).
Main Methods:
- Retrospective cohort study of 2346 children with AKI over a 9-year period.
- Analysis of AKI duration (transient, persistent, and acute kidney disease) and its correlation with mortality and CKD development.
Main Results:
- Acute kidney disease, a continuum of AKI, was associated with higher mortality rates (16.42%) compared to transient (14.66%) and persistent AKI (9.81%).
- Progression of kidney injury correlated with an increased incidence of intrinsic AKI causes.
- Factors like anemia, low platelets, and elevated procalcitonin were associated with poorer outcomes.
Conclusions:
- The progression of AKI to acute kidney disease significantly increases mortality risk in pediatric patients.
- New-onset chronic kidney disease following AKI is influenced by the intrinsic cause of the injury, rather than AKI severity.
Background:
Acute kidney injury (AKI) is associated with high morbidity and mortality. The continuum of kidney damage after an AKI episode is poorly explored in the paediatric population.
Methods:
We performed a retrospective cohort study on 2346 children with AKI from a tertiary care hospital in Romania over a 9-year period. The main objective was to evaluate the impact of AKI duration on mortality and the risk of new-onset chronic kidney disease (CKD).
Results:
Out of 2346 AKI patients, transient AKI was present in 655 patients (27.9%), persistent AKI in 1009 children (43%) and acute kidney disease in 682 patients (29.1%). In contrast to transient AKI, children who developed acute kidney disease were younger, with a higher degree of anaemia, lower number of platelets, higher procalcitonin, higher LDH, higher GGT, higher urea and higher serum creatinine levels. The pre-renal cause of AKI was the leading cause regardless of AKI duration. As kidney injury progressed over time, there was an increasing incidence of the intrinsic causes of AKI (11.1% in transient AKI, 13.2% in persistent AKI and 22.6% in acute kidney disease). Acute kidney disease patients had the highest mortality rate (16.42%), followed by transient AKI (14.66%) and persistent AKI (9.81%). Overall mortality increased in the presence of renal microvascular alterations, acute tubular necrosis, lower haemoglobin, serum proteins and platelets, and higher procalcitonin levels.
Conclusions:
The continuum of AKI expressed as acute kidney disease resulted in an increased risk of new-onset CKD. CKD was influenced by the intrinsic cause of AKI and not by AKI severity.
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