Long-term Risk of CKD in Children Surviving Episodes of Acute Kidney Injury in the Intensive Care Unit: A Prospective Cohort Study

Mammen, Cherry; Al Abbas, Abdullah; Skippen, Peter; Nadel, Helen; Levine, Daniel; Collet, J.P.; Matsell, Douglas G.

doi:10.1053/j.ajkd.2011.10.048

« Previous Next »American Journal of Kidney Diseases
Volume 59, Issue 4 , Pages 523-530, April 2012

Long-term Risk of CKD in Children Surviving Episodes of Acute Kidney Injury in the Intensive Care Unit: A Prospective Cohort Study

Cherry Mammen, MD, MHSc
- Department of Pediatrics, Division of Nephrology, Child & Family Research Institute, University of British Columbia, Vancouver, Canada
- Address correspondence to Cherry Mammen, MD, Division of Nephrology, Department of Pediatrics, BC Children's Hospital, 4480 Oak St, Vancouver, BC V6H3V4, Canada
Abdullah Al Abbas, MD
- Department of Pediatrics, Division of Nephrology, Child & Family Research Institute, University of British Columbia, Vancouver, Canada
Peter Skippen, MD
- Department of Pediatrics, Division of Critical Care Medicine, Child & Family Research Institute, University of British Columbia, Vancouver, Canada
Helen Nadel, MD
- Department of Pediatrics, Division of Radiology, Child & Family Research Institute, University of British Columbia, Vancouver, Canada
Daniel Levine, MD
- Department of Pediatrics, Division of Radiology, Child & Family Research Institute, University of British Columbia, Vancouver, Canada
J.P. Collet, MD, PhD
- Department of Pediatrics, Child & Family Research Institute, University of British Columbia, Vancouver, Canada
Douglas G. Matsell, MD
- Department of Pediatrics, Division of Nephrology, Child & Family Research Institute, University of British Columbia, Vancouver, Canada

Received 11 May 2011; accepted 18 October 2011. published online 30 December 2011.

Background

The development of standardized acute kidney injury (AKI) definitions has allowed for a better understanding of AKI epidemiology, but the long-term renal outcomes of AKI in the pediatric critical care setting have not been well established. This study was designed to: (1) determine the incidence of chronic kidney disease (CKD) in children 1-3 years after an episode of AKI at a tertiary-care pediatric intensive care unit (ICU), (2) identify the proportion of patients at risk of CKD, and (3) compare ICU admission characteristics in those with and without CKD.

Design

Prospective cohort study.

Setting & Participants

Patients admitted to the British Columbia Children's Hospital pediatric ICU from 2006-2008 with AKI, as defined by AKI Network (AKIN) criteria. Surviving patients, most with short-term recovery from their AKI, were assessed at 1, 2, or 3 years after AKI.

Predictors

Severity of AKI as defined by AKIN and several ICU admission characteristics, including demographics, diagnosis, severity of illness, and ventilation data.

Outcomes & Measurements

CKD was defined as the presence of albuminuria and/or glomerular filtration rate (GFR) <60 mL/min/1.73 m². Being at risk of CKD was defined as having a mildly decreased GFR (60-90 mL/min/1.73 m²), hypertension, and/or hyperfiltration (GFR ≥150 mL/min/1.73 m²).

Results

The proportion of patients with AKI stages 1, 2, and 3 were 44 of 126 (35%), 47 of 126 (37%), and 35 of 126 (28%), respectively. The number of patients with CKD 1-3 years after AKI was 13 of 126 (10.3% overall; 2 of 44 [4.5%] with stage 1, 5 of 47 [10.6%] with stage 2, and 6 of 35 [17.1%] with stage 3; P = 0.2). In addition, 59 of 126 (46.8%) patients were identified as being at risk of CKD.

Limitations

Several patients identified with AKI were lost to follow-up, with the potential of underestimating the incidence of CKD.

Conclusions

In tertiary-care pediatric ICU patients, ∼10% develop CKD 1-3 years after AKI. The burden of CKD in this population may be higher with further follow-up because several patients were identified as being at risk of CKD. Regardless of the severity of AKI, all pediatric ICU patients should be monitored regularly for long-term kidney damage.

Index Words: Pediatric , acute kidney injury , acute renal failure , Acute Kidney Injury Network (AKIN) , critically ill children , chronic kidney disease