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Long-term follow-up strategies for children after severe acute kidney injury
Giovanni Ceschia1,2, Donna J Claes3,4, Kelli A Krallman5
1Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. gio.ceschia@gmail.com.
Insights
Children with normal kidney function one year after acute kidney injury (AKI) have a low risk of developing chronic kidney disease (CKD) and can safely exit nephrology care.
Area of Science:
- Pediatric Nephrology
- Renal Medicine
- Kidney Disease Research
Background:
- Children with acute kidney injury (AKI) face a higher risk of developing chronic kidney disease (CKD).
- Early identification of high-risk patients is crucial for timely intervention.
- Indefinite follow-up for all AKI survivors may strain healthcare resources.
Purpose of the Study:
- To identify predictive factors for CKD after pediatric AKI.
- To determine if follow-up can be safely discontinued after one year for select patients.
Main Methods:
- Prospective evaluation of pediatric AKI patient outcomes.
- Assessment of hospitalization and first-year outpatient data.
- Analysis of estimated glomerular filtration rate (eGFR) and proteinuria at 3-5 years post-AKI.
Main Results:
- 96 pediatric patients were included in the study.
- Lower eGFR (<90 mL/min/1.73 m²) was associated with longer AKI duration, higher AKI stage, and increased need for kidney replacement therapy (KRT).
- No patient diagnosed with CKD at 3-5 years was free of CKD in the first year; only three patients with normal first-year eGFR developed abnormalities later, necessitating ongoing monitoring due to complex conditions.
Conclusions:
- Pediatric patients without indicators of CKD (eGFR <90 mL/min/1.73 m² or proteinuria) in the first year post-AKI demonstrate a low risk of developing CKD in subsequent years.
- Safe discontinuation of nephrology follow-up after one year is feasible for these low-risk patients.
- Absence of CKD in the first year post-AKI is a strong predictor of sustained kidney health up to 3-5 years.
Background:
Children experiencing acute kidney injury (AKI) are at heightened risk of developing chronic kidney disease (CKD). While identifying patients at high-risk for CKD after AKI early is crucial, indefinite follow-up may strain healthcare resources. We assessed potential predictive factors for CKD following AKI to guide safe discontinuation of follow-up after one year.
Methods:
We evaluated outcomes of children with AKI prospectively. We assessed for associations between hospitalization and first-year outpatient data with presence of estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m2 or CKD (eGFR <60 or 60-90 with proteinuria) at 3-5 years after AKI.
Results:
96 patients were included. Patients with eGFR <90 had longer AKI duration, higher prevalence of AKI stage 3, and received more KRT. No patient with CKD at 3-5 years was CKD-free in the first year of follow-up and only three patients with normal eGFR during the first year post-AKI had abnormal eGFR at 3-5 years; all had complex medical diseases which would necessitate kidney function monitoring as standard of care.
Conclusions:
Our data suggest patients without eGFR<90/CKD during the first year post-AKI have low CKD risk in the following 2-4 years and may be safely discharged from nephrology clinics after one year of follow-up.
Impact:
Patients without eGFR <90/CKD during the first year post-AKI have low CKD risk in the following 2-4 years. Lack of CKD in the first year post-AKI is maintained up to 3-5 years after the original episode. Patients without eGFR <90/CKD in the first year post-AKI can be safely discharged from nephrology care.
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