Ten percent rate of chronic kidney disease in children with acute kidney injury

At least 10 percent of children with acute kidney injury (AKI) in a children’s hospital intensive care unit (ICU) will experience chronic kidney disease (CKD) within the next few years, according to a report in the American Journal of Kidney Disease.

The researchers analyzed prospective follow-up data on 126 children with AKI admitted to the pediatric ICU in a Canadian children’s hospital from 2006 to 2008. (Another 173 children were lost to follow-up.) One-fourth of the patients were newborns; in more than half, AKI was associated with open-heart surgery.

As defined by AKI Network criteria, severity was stage 1 in 35 percent of children, stage 2 in 37 percent, and stage 3 in 28 percent. At 1–3 years of follow-up, the rates of CKD—defined as the presence of albuminuria and/or glomerular filtration rate (GFR) less than 60 mL/min/1.73 m2—was assessed.

At follow-up, the criteria for CKD were met in 10.3 percent of children who had stage 1 AKI, 10.6 percent with stage 2 AKI, and 17.1 percent with stage 3 AKI. Another 46.8 percent of children were considered at risk of CKD on the basis of mildly to moderately reduced kidney function (GFR 60–90 mL/min/1.73 m2), high blood pressure, or hyperfiltration (GFR 60–90 mL/min/1.73 m2).

Of these tertiary care pediatric ICU patients with AKI, more than 10 percent go on to experience CKD. Overall, most of these children either have CKD or are considered at risk for the development of CKD at follow-up. The authors believe that all children with AKI should receive regular monitoring for possible kidney damage [Mammen C, et al. Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis 2012; 59:523–530].

May 2012 (Vol. 4, Number 5)