Kidney Week

Abstract: FR-PO088

Adverse Long-Term Outcomes following AKI in Hospitalized Children: A Meta-Analysis

Session Information

• AKI: Diagnosis and Outcomes
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Meena, Jitendra, All India Institute of Medical Sciences, New Delhi, Delhi, India

Jitendra Meena, MD, MBBS

• Ali, Shanzey, McMaster Children's Hospital, Hamilton, Ontario, Canada

Shanzey Ali

• Kamran, Dua, University of Waterloo Faculty of Science, Waterloo, Ontario, Canada

Dua Kamran

• Sabeeh, Dima, McMaster University Faculty of Science, Hamilton, Ontario, Canada

Dima Sabeeh

• Ajoy, Heather Mary, Toronto Metropolitan University Faculty of Science, Toronto, Ontario, Canada

Heather Mary Ajoy

• Greenberg, Jason Henry, Yale University School of Medicine, New Haven, Connecticut, United States

Jason Henry Greenberg, MD, FASN

• Robinson, Cal, The Hospital for Sick Children, Toronto, Ontario, Canada

Cal Robinson, MBChB

• Yadav, Joginder Kumar, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India

Joginder Kumar Yadav, MD, MBBS

• Chanchlani, Rahul, McMaster Children's Hospital, Hamilton, Ontario, Canada

Rahul Chanchlani, MD, MBBS, MS, FASN

Background

Acute kidney injury (AKI) is common during pediatric hospitalizations and is associated with adverse short-term outcomes. However, long-term outcomes among survivors of pediatric AKI remain uncertain. We performed a systematic review to determine the risk of long-term outcomes following an episode of AKI.

Methods

We conducted a systematic literature search in EMBASE, PubMed, and Web of Science for studies reporting adverse events at least three months following AKI defined using standardized definitions in participants aged <18 year. We excluded studies if they reported outcomes in children with obstructive lesions, renal vascular disorder (i.e HUS), or solid organ transplantations. Random effect meta-analyses were performed to calculate pooled estimates.

Results

Of 12817 records identified through our initial search, 38 studies (14892 participants) were included in the final analysis. Pooled cumulative incidence of participants with CKD, mortality, proteinuria, and hypertension was 16% (95% CI: 12 to 19), 6% (3 to 8), 19% (11 to 26) and 13% (10 to 17) respectively, following an episode of AKI. Only 24 studies with follow up period ranging from 6 months to 15 years included a comparator group of patients without AKI. The odds of developing CKD was higher among children with AKI as compared to those without AKI (OR: 1.57, 95% CI: 1.05 to 2.35; Figure 1). Mortality was also higher after AKI (OR: 1.84, 95% CI: 1.28 to 2.63). There was no significant association between AKI and proteinuria (OR: 1.13, 0.63 to 2.03) or hypertension (OR: 1.27, 0.75 to 2.15) at follow up.

Conclusion

Children with AKI are at a higher risk of developing long-term CKD and mortality. These findings support enhanced surveillance of kidney function after an episode of AKI, with the aim of improving long-term kidney and patient survival.

Pooled odds ratio of chronic kidney disease