Healthcare Utilization after Acute Kidney Injury in the Pediatric Intensive Care Unit

Hessey, Erin; Morissette, Geneviève; Lacroix, Jacques; Perreault, Sylvie; Samuel, Susan; Dorais, Marc; Phan, Véronique; Jouvet, Philippe; Lafrance, Jean‐Philippe; LeLorier, Jacques; Palijan, Ana; Pizzi, Michael; Roy, Louise; Zappitelli, Michael

doi:10.2215/cjn.09350817

Cited by 51 publications

(44 citation statements)

References 30 publications

(27 reference statements)

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“…21 In noncardiac surgery children admitted to the intensive care unit, AKI has been shown to be associated with increased health care use, including postdischarge hospitalizations, physician visits, and other important health outcomes. 8,22,23 Therefore, given the known strong association of AKI with readmission and other outcomes in non-cardiac surgery populations, these findings are notable. Children undergoing cardiac surgery are at high risk of readmission, which prompts an urgent need to find easily identifiable, strong predictors that would allow for targeted interventions to reduce readmission.…”

Section: Discussionmentioning

confidence: 92%

The association of acute kidney injury with hospital readmission and death after pediatric cardiac surgery

et al. 2020

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Background: Acute kidney injury (AKI) in children undergoing cardiac surgery (CS) is strongly associated with increased hospital mortality and length of stay. The association of AKI with postdischarge outcomes is unclear. We evaluated the association of AKI with all-cause readmissions and death within 30 days and 1 year of CS discharge. Methods: This was a prospective, 3-center cohort study of children after CS with cardiopulmonary bypass. The primary exposures were postoperative stage 1 AKI and stage 2 AKI defined by Kidney Disease: Improving Global Outcomes AKI definition. Two separate outcomes were hospital readmission and death within 30 days and 1 year of discharge. Association of AKI with time to outcomes was determined using multivariable Cox-proportional hazards analysis. Age, The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery risk adjustment tool score 3, cardiopulmonary bypass >120 minutes, and cyanotic heart disease were evaluated as effect modifiers. PERSPECTIVE Reducing postoperative readmission and death is a priority. This is the first prospective cohort study to evaluate the relationship between AKI and post-cardiac surgery discharge readmission in children. Identifying risk factors for readmission and death may enable targeted follow up of atrisk groups and potentially decrease long-term morbidity and mortality. See Commentaries on pages 86 and 88.

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Section: Discussionmentioning

confidence: 92%

The association of acute kidney injury with hospital readmission and death after pediatric cardiac surgery

et al. 2020

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“…Patients with pAKI had higher rates of AKI in the 6 months prior to transplant and had more episodes of AKI in the first 12 months post‐transplant. Hessey et al 26 have shown that patients who develop AKI are more likely to be hospitalized again after discharge from their index admission, even after adjusting for confounders. Other studies in adult patients show that up to a third of those who have an episode of AKI are likely to have at least one more episode and a significant number of patients experience multiple episodes of AKI 27 .…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury and chronic kidney disease after non‐kidney solid organ transplantation

Menon

Pollack

Sullivan

et al. 2020

Pediatric Transplantation

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Background SOT is the treatment of choice for end‐stage organ disease. Improved long‐term survival after NKSOT has uncovered chronic morbidity including CKD. AKI is common after NKSOT and may be associated with long‐term CKD. Methods We performed a retrospective cohort study looking at AKI and CKD after pediatric heart (n = 109) or liver (n = 112) transplant. AKI was defined using KDIGO creatinine‐based criteria. pAKI was AKI ≤ 7 days post‐transplant; CKD3‐5 was eGFR < 60 mL/min/1.73 m2 by modified Schwartz formula for > 3 months. We looked at the incidence of CKD3‐5 and the effect of perioperative pAKI on the slope of eGFR post‐transplant. Results pAKI was seen in 63% (n = 69) after heart and 38% (n = 43) after liver transplant. pAKI was associated with longer ICU and hospital stays. Cumulative incidence (95% CI) of CKD3‐5 at 60 months post‐heart transplant was 40.9% (27.9%‐57.1%) in patients with AKI vs 35.8% (17.1%‐64.8%) in those without (P = NS). Post‐liver transplant, the cumulative incidence of CKD3‐5 at 60 months was 0% in those without pAKI vs 10% (3.2%‐29.3%) in those with (P = .01). Patients with pAKI had lower eGFR at last follow‐up. Conclusion pAKI and CKD are common after NKSOT. Incidence of CKD is higher in those with pAKI. AKI episodes are associated with a drop in eGFR during follow‐up. Identifying patients who have had AKI is an important first step in identifying those at risk of repeated AKI episodes. These patients would benefit from closer monitoring for CKD, lower nephrotoxic drug use, and follow‐up with nephrology.

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“…Acute kidney injury (AKI) is defined as an abrupt onset of kidney dysfunction. AKI occurs in 20-30% of the general pediatric intensive care (PICU) population and up to 50% in children following cardiac surgery (1)(2)(3)(4)(5)(6). Compared to children who do not develop AKI in the PICU, children with AKI are at higher risk of poor early outcomes, including mortality, receipt and longer duration of mechanical ventilation, and prolonged length of PICU and subsequent hospital stay (7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years

et al. 2021

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Acute kidney injury (AKI) in the pediatric intensive care unit (PICU) is an important risk factor for increased morbidity and mortality during hospitalization. Over the past decade, accumulated data on children and young people indicates that acute episodes of kidney dysfunction can have lasting consequences on multiple organ systems and health outcomes. To date, there are no guidelines for follow-up of surviving children that may be at risk of long-term sequelae following AKI in the PICU. This narrative review aims to describe literature from the last 5 years on the risk of medium and long-term kidney and non-kidney outcomes after AKI in the PICU. More specifically, we will focus on outcomes in children and young people following AKI in the general PICU population and children undergoing cardiac surgery. These outcomes include mortality, hypertension, proteinuria, chronic kidney disease, and healthcare utilization. We also aim to highlight current gaps in knowledge in medium and long-term outcomes in this pediatric population. We suggest a framework for future research to develop evidence-based guidelines for follow-up of children surviving an episode of critical illness and AKI.

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Healthcare Utilization after Acute Kidney Injury in the Pediatric Intensive Care Unit

Abstract: AKI is independently associated with higher hospitalizations and physician visits postdischarge.

Cited by 51 publications

References 30 publications

The association of acute kidney injury with hospital readmission and death after pediatric cardiac surgery

The association of acute kidney injury with hospital readmission and death after pediatric cardiac surgery

Acute kidney injury and chronic kidney disease after non‐kidney solid organ transplantation

Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years

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