Long-Term Kidney Outcomes Following Dialysis-Treated Childhood Acute Kidney Injury: A Population-Based Cohort Study.

Tytuł:: Long-Term Kidney Outcomes Following Dialysis-Treated Childhood Acute Kidney Injury: A Population-Based Cohort Study.
Autorzy:: Robinson CH; Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
Jeyakumar N; ICES, London, Ontario, Canada.
Luo B; ICES, London, Ontario, Canada.
Wald R; Division of Nephrology, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
Garg AX; ICES, London, Ontario, Canada.
Nash DM; ICES, London, Ontario, Canada.
McArthur E; ICES, London, Ontario, Canada.
Greenberg JH; Division of Nephrology, Department of Pediatrics, Yale University, New Haven, Connecticut.
Askenazi D; Division of Pediatric Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
Mammen C; Division of Nephrology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Thabane L; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.; Biostatistics Unit, St Joseph's Healthcare, Hamilton, Ontario, Canada.
Goldstein S; Center for Acute Care Nephrology, Cincinnati Children's Hospital, Cincinnati, Ohio.
Parekh RS; Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
Zappitelli M; Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
Chanchlani R; ICES, London, Ontario, Canada.; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.; Division of Pediatric Nephrology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
Źródło:: Journal of the American Society of Nephrology : JASN [J Am Soc Nephrol] 2021 Aug; Vol. 32 (8), pp. 2005-2019. Date of Electronic Publication: 2021 May 26.
Typ publikacji:: Journal Article; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Publication: 2023- : Hagerstown, MD : Wolters Kluwer Health, on behalf of the American Society of Nephrology
Original Publication: Baltimore, MD : Williams & Wilkins, c1990-
MeSH Terms:: Renal Dialysis*
Acute Kidney Injury/*therapy
Kidney Failure, Chronic/*epidemiology
Adolescent ; Case-Control Studies ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Hypertension/epidemiology ; Incidence ; Infant ; Infant, Newborn ; Male ; Mortality ; Ontario/epidemiology ; Proportional Hazards Models ; Renal Insufficiency, Chronic/epidemiology ; Retrospective Studies ; Risk Factors ; Survivors/statistics & numerical data ; Time Factors
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Grant Information:: UL1 TR001863 United States TR NCATS NIH HHS
Contributed Indexing:: Keywords: acute renal failure; blood pressure; children; chronic kidney disease; clinical epidemiology; dialysis; end stage kidney disease; hypertension; mortality; pediatric nephrology
Entry Date(s):: Date Created: 20210527 Date Completed: 20211018 Latest Revision: 20230203
Update Code:: 20240105
PubMed Central ID:: PMC8455253
DOI:: 10.1681/ASN.2020111665
PMID:: 34039667
: Czasopismo naukowe

Background: AKI is common during pediatric hospitalizations and associated with adverse short-term outcomes. However, long-term outcomes among survivors of pediatric AKI who received dialysis remain uncertain.
Methods: To determine the long-term risk of kidney failure (defined as receipt of chronic dialysis or kidney transplant) or death over a 22-year period for pediatric survivors of dialysis-treated AKI, we used province-wide health administrative databases to perform a retrospective cohort study of all neonates and children (aged 0-18 years) hospitalized in Ontario, Canada, from April 1, 1996, to March 31, 2017, who survived a dialysis-treated AKI episode. Each AKI survivor was matched to four hospitalized pediatric comparators without dialysis-treated AKI, on the basis of age, sex, and admission year. We reported the incidence of each outcome and performed Cox proportional hazards regression analyses, adjusting for relevant covariates.
Results: We identified 1688 pediatric dialysis-treated AKI survivors (median age 5 years) and 6752 matched comparators. Among AKI survivors, 53.7% underwent mechanical ventilation and 33.6% had cardiac surgery. During a median 9.6-year follow-up, AKI survivors were at significantly increased risk of a composite outcome of kidney failure or death versus comparators. Death occurred in 113 (6.7%) AKI survivors, 44 (2.6%) developed kidney failure, 174 (12.1%) developed hypertension, 213 (13.1%) developed CKD, and 237 (14.0%) had subsequent AKI. AKI survivors had significantly higher risks of developing CKD and hypertension versus comparators. Risks were greatest in the first year after discharge and gradually decreased over time.
Conclusions: Survivors of pediatric dialysis-treated AKI are at higher long-term risks of kidney failure, death, CKD, and hypertension, compared with a matched hospitalized cohort.
(Copyright © 2021 by the American Society of Nephrology.)

Comment in: J Am Soc Nephrol. 2021 Oct;32(10):2681-2682. (PMID: 34531178)
Comment in: J Am Soc Nephrol. 2021 Oct;32(10):2679. (PMID: 34531179)
Comment in: J Am Soc Nephrol. 2021 Oct;32(10):2680. (PMID: 34531180)

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