Late Outcomes Following Acute Kidney Injury in Children: A Systematic Review and Meta-Analysis

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.