Acute Kidney Disease in Hospitalized Pediatric Patients With Acute Kidney Injury in China

Abstract

ObjectiveThe epidemiology and outcomes of acute kidney disease (AKD) after acute kidney injury (AKI) in hospitalized children are poorly described. The aim of this study is to investigate the prevalence, predictive factors, and clinical outcomes of AKD in hospitalized children with AKI.MethodsChildren (1 month–18 years) with AKI during hospitalization in the Second Xiangya Hospital from January 2015 to December 2020 were identified. AKD was defined based on the consensus report of the Acute Disease Quality Initiative 16 workgroup. The endpoints include adverse outcomes in 30 and 90 days. Multivariable logistic regression analyses were used to estimate the odds ratio of 30- and 90-day adverse outcomes associated with AKD and identify the risk factors of AKD.ResultsAKD was developed in 42.3% (419/990) of the study patients, with 186 in AKD stage 1, 107 in AKD stage 2, and 126 in AKD stage 3. Pediatric patients with AKD stages 2–3 had significantly higher rates of developing 30- and 90-day adverse outcomes than those with AKD stage 0 and 1. The adjusted odds ratio of AKD stage 2–3 was 12.18 (95% confidence interval (CI), 7.38 - 20.09) for 30-day adverse outcomes and decreased to 2.49 (95% CI, 1.26 - 4.91) for 90-day adverse outcomes. AKI stages 2 and 3, as well as glomerulonephritis, were the only predictive factors for AKD stage 2–3.ConclusionAKD is frequent among hospitalized pediatric AKI patients. AKD stage 2–3 represents a high-risk subpopulation among pediatric AKI survivors and is independently associated with 30- and 90-day adverse outcomes. Awareness of the potential risks associated with AKD stage 2–3 and its risk factors may help improve outcomes through careful monitoring and timely intervention.

Acute kidney injury in children: incidence, awareness and outcome – a retrospective cohort study

“…Exposure to sepsis, critical illness, hypovolemic shock and the need for mechanical ventilation increased the mortality signi cantly, with similar results previously published [23,24], while cancer and heart failure were the most signi cant susceptibilities encountered with impact on mortality. In the presence of a hospitalized patient, the physician should be aware of the risk of developing AKI keeping in mind that AKI is often a result of multiple renal insults.…”

“…In our cohort we report a high incidence of AKD (17.8%). The severity of AKI and the extension in time of increased serum creatinine is associated with worse outcome as previously published in AWAKEN [3], AWARE [4], Baby-Ninja [7], AKI-EPI [21] studies as well as in many other regional studies in both critically and non-critically ill patients [1,14,22,23].…”

Update on prognosis driven classification of pediatric AKI

“…Table 4 outlines pediatric and adult studies of AKD epidemiology, risk factors, and outcomes. Pediatric studies in special populations have shown variable incidence of AKD ranging from 6.2% in children undergoing cardiopulmonary bypass, 13% in nonkidney solid organ transplant recipients, 15.6% in children with severe malaria infection, 35.3% in allogeneic hematopoietic stem cell recipients, and 42.3% in hospitalized children with AKI (16,(27)(28)(29)(30). Adult studies have shown even more variability with incidence ranging from 3.8% in the general adult population of a single Canadian territory to 4.4%-74% in adults of special populations including those undergoing cardiac and non-cardiac procedure, chemotherapy, hematopoietic stem cell transplant recipients, those with AKI, heart failure, sepsis, cirrhosis, and SARS-CoV-2 infection (20).…”

“…Risk factors for AKD in children have not been widely studied. Few studies that have been published demonstrated a higher risk of AKD in children with higher stages of AKI with one study showing that stage of AKI predicted AKD in a graded manner (16,27,29). Though stage of AKI has been shown to be an important risk factor for progression to AKD, studies in adults and children have shown patient-level and acquired risk factors independently increased risk of AKD independent of AKI stage suggesting that patients with lower stages of AKI also deserve close evaluation for AKD risk.…”

“…A study of children who have undergone hematopoietic stem cell transplant showed that older age, higher baseline eGFR and higher body mass index (BMI) were associated with increased risk of AKD (28). A study of a more general population of hospitalized children also showed that children with glomerulonephritis compared to other AKI etiologies were at higher risk for developing AKD after AKI suggesting that intrinsic kidney disease may also be an important predictor of progression to AKD (29). Although this is the only study assessing AKI etiology as a risk factor for AKD in pediatrics, a study in adults hospitalized with AKI showed similar results when evaluating intrinsic kidney injury and rates of AKD suggesting that AKI etiology is also an important consideration when evaluating a patient's prognosis for kidney recovery (31).…”