24-Hour ambulatory blood pressure monitoring 7 years after intensive care unit admission

Hessey, Erin; Paun, Alex; Benisty, Kelly; McMahon, Kelly R.; Palijan, Ana; Pizzi, Michael; Morgan, Catherine; Zappitelli, Michael

doi:10.1007/s00467-021-05392-2

Cited by 1 publication

(1 citation statement)

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“…Long-term outcomes of pediatric AKI are less established and there is a lack of consensus on optimal follow-up [12][13][14][15]. Studies using administrative health data have shown that pediatric AKI is associated with post-discharge diagnosis of HTN and CKD and increased healthcare utilization [16][17][18][19][20][21][22] ; however, these data are limited to speci c geographic areas in North America and there is a lack of con rmatory prospective data on AKI vs. non-AKI long-term patient outcomes. The recently published rst pediatric Acute Disease Quality Initiative strongly prioritized understanding the natural history and long-term outcomes of pediatric AKI to develop follow-up recommendations based on real-life pediatric data [23].…”

Section: Introductionmentioning

confidence: 99%

Kidney and Blood Pressure Outcomes 11 Years After Acute Kidney Injury in Critically Ill Children: A Prospective Cohort Study

Ulrich,

Yordanova,

Morgan

et al. 2024

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Background: Acute kidney injury (AKI) is common in critically ill children and associated with adverse short-term outcomes; however, long-term outcomes are not well described. Methods: This longitudinal prospective cohort study examined the prevalence of chronic kidney disease (CKD) and hypertension (HTN) 11- vs. 6 years after pediatric intensive care unit (PICU) admission and association with AKI. We examined children (age <19 years) without pre-existing kidney disease 11±1.5 years after PICU admission at a single center. AKI was defined using serum creatinine criteria. The primary outcome was a composite of CKD or HTN. CKD was defined as estimated glomerular filtration rate (eGFR) <90 mL/min/1.73m2 or albuminuria. Multivariable analyses compared outcomes at 11 vs. 6-year follow-up and association with AKI during PICU admission. Results: Of 96 children evaluated 11 years after PICU admission, 16% had evidence of CKD or HTN (versus 28% at 6 years, p<0.05). Multivariable analysis did not show improvement in outcomes from 6- to 11-year follow-up. eGFR decreased from 6- to 11-year follow-up (adjusted coefficient -11.7, 95% CI: -17.6 to -5.9) and systolic and diastolic blood pressures improved. AKI was associated with composite outcome at 6-year (adjusted odds ratio (aOR): 12.7, 95% CI: 3.2-51.2, p<0.001), but not 11-year follow-up (p=0.31). AKI was associated with CKD (aOR 10.4, 95% CI: 3.1-34.7) at 11 years. Conclusions: This study provides novel data showing that adverse kidney and blood pressure outcomes remain highly prevalent 10 years after critical illness in childhood. The association with AKI wanes over time.

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