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Late Outcomes Following Acute Kidney Injury in Children: A Systematic Review and Meta-Analysis
Jitendra Meena1, Shanzey Ali2, Cal Robinson3
1Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India.
Insights
Hospitalized children with acute kidney injury (AKI) face increased risks of chronic kidney disease (CKD) and mortality. Structured follow-up care is crucial for managing these long-term adverse outcomes.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Epidemiology
Background:
- Acute kidney injury (AKI) is a frequent complication in hospitalized children, potentially leading to long-term kidney and cardiovascular issues.
- The comprehensive long-term risks following pediatric AKI remain insufficiently quantified.
Purpose of the Study:
- To determine the pooled incidence and relative risk of chronic kidney disease (CKD), mortality, hypertension, and proteinuria after pediatric AKI.
- To assess the association between AKI and adverse long-term outcomes in children.
Main Methods:
- A systematic review and meta-analysis of studies published between January 2007 and November 2025.
- Inclusion of studies reporting long-term outcomes (CKD, mortality, hypertension, proteinuria) in hospitalized children with AKI, excluding specific conditions like obstructive lesions or transplant.
- Random-effects meta-analyses were used to estimate pooled cumulative incidences and odds ratios (ORs).
Main Results:
- The study analyzed 39 studies with 16,151 participants.
- Pooled cumulative incidences post-AKI: 17% for CKD, 6% for mortality, 20% for proteinuria, and 16% for hypertension.
- AKI was associated with increased odds of CKD (OR=1.74) and mortality (OR=1.92) compared to non-AKI controls. Higher AKI severity correlated with greater odds of CKD.
Conclusions:
- Pediatric AKI significantly increases the risk of long-term adverse outcomes, including CKD and mortality, mirroring findings in adult populations.
- These results underscore the necessity of implementing structured follow-up protocols for children who have experienced AKI.
Importance:
Acute kidney injury (AKI) is a common complication among hospitalized children and may have lasting kidney and cardiovascular consequences. However, the long-term risks after pediatric AKI have not been comprehensively quantified.
Objective:
To estimate the pooled incidence and relative risk with odds ratio of chronic kidney disease (CKD), mortality, hypertension, and proteinuria following AKI in hospitalized children.
Data Sources:
PubMed, Embase, and Web of Science were searched from January 2007 through November 2025 without language restrictions.
Study Selection:
Studies were included if they reported at least 1 long-term outcome (CKD, mortality, hypertension, or proteinuria) following AKI in hospitalized children. Studies limited to children with obstructive lesions, primary vascular disorders (eg, hemolytic uremic syndrome) or solid organ transplant were excluded.
Data Extraction And Synthesis:
Two reviewers independently extracted data and assessed risk of bias. Random-effects meta-analyses were performed to estimate pooled cumulative incidences and odds ratios (ORs) with 95% CIs.
Main Outcomes And Measures:
Cumulative incidence and odds of CKD, mortality, hypertension, and proteinuria following pediatric AKI.
Results:
Of 17 068 screened records, 39 studies comprising 16 151 participants were included. The pooled cumulative incidences following AKI were 17% (95% CI, 12-22) for CKD, 6% (95% CI, 3-8) for mortality, 20% (95% CI, 12-29) for proteinuria, and 16% (95% CI, 11-23) for hypertension. In 23 studies with non-AKI comparators and follow-up ranging from 3 months to 18 years, AKI was associated with increased odds of CKD (OR, 1.74; 95% CI, 1.02-2.95) and mortality (OR, 1.92; 95% CI, 1.35-2.75) but not proteinuria (OR, 1.18; 95% CI, 0.62-2.25) or hypertension (OR, 1.29; 95% CI, 0.72-2.31). Greater AKI severity was associated with a higher odds of CKD (stages 2-3: OR, 2.84; 95% CI, 1.49-4.15; stage 1: OR, 1.72; 95% CI, 1.11-2.67).
Conclusions And Relevance:
The findings in this systematic review and meta-analysis demonstrate that, similar to adults, children experienced increased risk of late adverse outcomes following AKI, particularly CKD and mortality, supporting the need for structured post-AKI follow up.
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