Secular Trends in Incidence, Modality and Mortality with Dialysis Receiving AKI in Children in Ontario

Abstract

Background and objectivesThere is a limited appreciation of the epidemiology of dialysis-receiving AKI in children. The primary objective of the study was to evaluate changes in the incidence of dialysis-receiving AKI among children over a period of 20 years in Ontario, Canada. The secondary objectives were to assess temporal trends in the utilization of various dialysis modalities and 30-day mortality among children with dialysis-receiving AKI.Design, setting, participants, & measurementsAll children (29 days to 18 years) who received their first dialysis for AKI between 1996 and 2015 were identified from healthcare administrative databases. Those who received dialysis for ESKD, inborn errors of metabolism, and poisonings were excluded. The incidence rates of dialysis-receiving AKI were reported annually. The Cochran—Armitage test was used to assess trends in the incidence and short-term mortality after dialysis-receiving AKI.ResultsWe identified 1394 children treated with dialysis for AKI during a hospital stay. There was a significant increase in the incidence of dialysis-receiving AKI among hospitalized children from 1996 (0.58 per 1000 person-years) to 2015 (0.65 per 1000 person-years) (P=0.01). The use of continuous kidney replacement therapy and intermittent hemodialysis increased whereas the relative use of peritoneal dialysis declined over time. Thirty-day mortality rates after dialysis-receiving AKI increased from 14% to 25% between 1996 and 2009 and reduced to 19% in the more recent years (P=0.03).ConclusionsIn Ontario, the incidence of dialysis-receiving AKI among children has increased between 1996 and 2015. The use of peritoneal dialysis for AKI has declined and the short-term mortality after dialysis-receiving AKI has increased.

Changing trends in dialysis modalities utilization and mortality in children, adolescents and young adults with acute kidney injury, 2010–2017

“…Our results are consistent with previous studies that reported the overall mortality in pediatric patients with dialysis for AKI ranged from 19 to 44.7% 5 , 8 , 9 , 21 , 30 . Results from a present study demonstrated that patients receiving CKRT required more frequent use of ECMO and more vasoactive inotropic medications (based on the sum of VIS medication regimens being ≥ 2), which is consistent with needs for ICU care as well as higher mortality risk.…”

“…Among hospitalized patients who underwent dialysis, the sex and age distribution of this study’s cohort are similar to previous studies from single-center 9 and population-based cohorts 21 . However, the patterns of dialysis modality utilization appeared to change by the time CKRT became more accessible in different countries.…”

“…A previous study reported the incidence of dialysis in pediatric patients treated for AKI increased by 7% per year (2000–2009) in the pediatric population of the United States using ICD-9 coded AKI combined procedure codes for dialysis 20 . The incidence of dialysis-requiring AKI was defined by acute procedure coder for dialysis used in the health care system and found to slightly decline from 0.03/100 person-years to 0.02/100 person-years (1996–2015) in a Canadian pediatric population in the province of Ontario 21 . Although cases of pediatric patients with dialysis for AKI slightly increased (Fig.…”

“…For instance, a recent survey of 35 pediatric nephrology centers in 11 European countries reported that PD and CKRT were the most frequently used dialysis modalities for treating pediatric AKI, accounting for 39.4% and 38.2% of all treatments, followed by use of intermittent HD (22.4%) 26 . Over the period of 2010–2015, CKRT (with an annual rate ranging from 38 to 52%) and intermittent HD (annual rate ranging from 12 to 24%) were more commonly performed in pediatric patients in Ontario 21 . Our results showed that intermittent and CKRT were the predominant dialysis modalities for hospitalized pediatric patients.…”

The diagnostic value of combined indexes in Acute Renal injury after Cardiopulmonary Bypass Surgery in infants with Congenital Heart Disease

“…Previous studies on AKI have mostly focused on adult and adolescent patients [19][20][21], and the investigation and study to evaluate the acute kidney injury of infants after operation are relatively rare,complications, hospitalization expenses and other adverse consequences of AKI in hospitalized infants are no less than those of adults, and the physiological regulation function of infants's own organs is worse than that of adults, which often results in worse prognosis than adults [22,23]. For this reason, researchers have made appropriate improvements in the diagnosis and treatment of AKI in infants with congenital heart diseases compared with adults, and tried to find more sensitive and accurate markers to monitor the occurrence and development of AKI in infants [24,25].…”