Long-term risk of chronic kidney disease and mortality in children after acute kidney injury: A systematic review

Jason H. Greenberg, Steven Coca, Chirag Parikh

Research output: Contribution to journalReview article

Abstract

Background: Acute kidney injury (AKI) is associated with significant short-term morbidity and mortality in children. However, the risk for long-term outcomes after AKI is largely unknown. Methods: We performed a systematic review and meta-analysis to determine the cumulative incidence rate of proteinuria, hypertension, decline in glomerular filtration rate (GFR), and mortality after an episode of AKI. After screening 1934 published articles from 1985-2013, we included 10 cohort studies that reported long-term outcomes after AKI in children. Results: A total of 346 patients were included in these studies with a mean follow-up of 6.5 years (range 2-16) after AKI. The studies were of variable quality and had differing definitions of AKI with five studies only including patients who required dialysis during an AKI episode. There was a substantial discrepancy in the outcomes across these studies, most likely due to study size, disparate outcome definitions, and methodological differences. In addition, there was no non-AKI comparator group in any of the published studies. The cumulative incidence rates for proteinuria, hypertension, abnormal GFR (<90 ml/min/1.73 m2), GFR < 60 ml/min/1.73 m2, end stage renal disease, and mortality per 100 patient-years were 3.1 (95% CI 2.1-4.1), 1.4 (0.9-2.1), 6.3 (5.1-7.5), 0.8 (0.4-1.4), 0.9 (0.6-1.4), and 3.7 (2.8-4.5) respectively. Conclusions: AKI appears to be associated with a high risk of long-term renal outcomes in children. These findings may have implications for care after an episode of AKI in children. Future prospective studies with appropriate non-AKI comparator groups will be required to confirm these results.

Original languageEnglish (US)
Article number184
JournalBMC Nephrology
Volume15
Issue number1
DOIs
StatePublished - Nov 21 2014

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Child Mortality
Chronic Renal Insufficiency
Acute Kidney Injury
Glomerular Filtration Rate
Kidney
Proteinuria
Episode of Care
Hypertension
Mortality
Incidence
Wounds and Injuries
Chronic Kidney Failure
Meta-Analysis
Dialysis
Cohort Studies
Outcome Assessment (Health Care)
Prospective Studies
Morbidity

Keywords

  • Acute kidney injury
  • Chronic kidney disease
  • Hypertension
  • Long-term survival
  • Pediatrics
  • Progression
  • Proteinuria

ASJC Scopus subject areas

  • Nephrology

Cite this

Long-term risk of chronic kidney disease and mortality in children after acute kidney injury : A systematic review. / Greenberg, Jason H.; Coca, Steven; Parikh, Chirag.

In: BMC Nephrology, Vol. 15, No. 1, 184, 21.11.2014.

Research output: Contribution to journalReview article

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abstract = "Background: Acute kidney injury (AKI) is associated with significant short-term morbidity and mortality in children. However, the risk for long-term outcomes after AKI is largely unknown. Methods: We performed a systematic review and meta-analysis to determine the cumulative incidence rate of proteinuria, hypertension, decline in glomerular filtration rate (GFR), and mortality after an episode of AKI. After screening 1934 published articles from 1985-2013, we included 10 cohort studies that reported long-term outcomes after AKI in children. Results: A total of 346 patients were included in these studies with a mean follow-up of 6.5 years (range 2-16) after AKI. The studies were of variable quality and had differing definitions of AKI with five studies only including patients who required dialysis during an AKI episode. There was a substantial discrepancy in the outcomes across these studies, most likely due to study size, disparate outcome definitions, and methodological differences. In addition, there was no non-AKI comparator group in any of the published studies. The cumulative incidence rates for proteinuria, hypertension, abnormal GFR (<90 ml/min/1.73 m2), GFR < 60 ml/min/1.73 m2, end stage renal disease, and mortality per 100 patient-years were 3.1 (95{\%} CI 2.1-4.1), 1.4 (0.9-2.1), 6.3 (5.1-7.5), 0.8 (0.4-1.4), 0.9 (0.6-1.4), and 3.7 (2.8-4.5) respectively. Conclusions: AKI appears to be associated with a high risk of long-term renal outcomes in children. These findings may have implications for care after an episode of AKI in children. Future prospective studies with appropriate non-AKI comparator groups will be required to confirm these results.",
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