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A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
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Progression of acute kidney injury to chronic kidney disease: a prospective cohort study

Shreyashi Karmakar1, Deblina Dasgupta1, Shakil Akhtar1

  • 1Division of Pediatric Nephrology, Institute of Child Health, Kolkata, India.

Pediatric Nephrology (Berlin, Germany)
|May 21, 2025
PubMed

Insights

Kidney damage is common in critically ill children in low-income countries. Many survivors of acute kidney injury (AKI) develop long-term kidney problems, highlighting the need for more research.

Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Global Health

Background:

  • Studies on kidney outcomes in critically ill children with acute kidney injury (AKI) are limited in low- and middle-income countries (LMICs).
  • This pilot study aimed to investigate the progression from AKI to acute kidney disease (AKD) and chronic kidney disease (CKD) in a pediatric intensive care unit (PICU) in an LMIC.

Purpose of the Study:

  • To evaluate the continuum of kidney outcomes in critically ill children following AKI.
  • To assess the incidence of transient AKI, persistent AKI, AKD, and CKD at 3 months post-AKI onset.
  • To identify risk factors for CKD development in this population.

Main Methods:

  • A prospective pilot study included children aged 1-18 years admitted to a tertiary PICU who developed AKI without pre-existing kidney conditions.
  • AKI and CKD were defined using KDIGO 2012 criteria.
  • Follow-up assessments at 1 and 3 months post-AKI onset included evaluation for albuminuria, hypertension, and estimated glomerular filtration rate (eGFR).

Main Results:

  • 15% of 390 children developed AKI, with 75% having a non-kidney systemic etiology.
  • Among 40 AKI survivors with 3-month data, incidences were: transient AKI (40%), persistent AKI (20%), AKD (32%), and CKD (8%).
  • 18% were at risk of CKD, and AKI duration >48 hours was associated with increased risk of CKD or being at risk (p=0.025).

Conclusions:

  • Kidney sequelae, including AKD and CKD, are prevalent at 3 months among PICU AKI survivors in this LMIC setting.
  • This pilot study demonstrates the feasibility of prospective research on pediatric AKI outcomes in LMICs.
  • Larger prospective trials are warranted to better understand the long-term kidney outcomes for all children with AKI in resource-limited environments.
Abstract

Keywords:
Acute kidney diseaseAcute kidney injuryChronic kidney diseaseCritical careLong-term outcomePediatric intensive care unit

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