Kidney Week

Abstract: TH-OR112

Long-Term Outcomes after AKI Requiring Dialysis Among Neonates and Children in Ontario: A Population-Based Study

Session Information

• Predicting AKI and Clinical Outcomes
  October 25, 2018 | Location: 1B, San Diego Convention Center
  Abstract Time: 04:42 PM - 04:54 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

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

Rahul Chanchlani, MD, MBBS



Dr. Chanchlani is an Assistant Professor in the Division of Nephrology, Department of Pediatrics at McMaster University, Hamilton, Canada. He is also an Associate Faculty in the Department of Health Research Methods, Evidence, and Impact (HEI) at McMaster University. He conducts population-based clinical research on the epidemiology of common neonatal and pediatric renal problems such as acute kidney injury, chronic kidney disease, kidney transplant, nephrotic syndrome, and hypertension.

• Nash, Danielle Marie, London Health Sciences Centre, London, Ontario, Canada

Danielle Marie Nash,

• McArthur, Eric, Institute for Clinical Evaluative Sciences, London, Ontario, Canada

Eric McArthur,

• Zappitelli, Michael, Toronto Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

Michael Zappitelli,

• Kuwornu, John paul, Government of Saskatchewan, Regina, Saskatchewan, Canada

John paul Kuwornu,

• Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada

Amit X. Garg,

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

Jason Henry Greenberg,

• Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Stuart Goldstein,

• Wald, Ron, St. Michael's Hospital, Toronto, Ontario, Canada

Ron Wald,

Background

There is limited knowledge on the long-term impact of an episode of acute kidney injury requiring dialysis (AKI-D) among neonates and children.

Methods

Using health administrative databases housed at the Institute for Clinical Evaluative Sciences, we conducted a retrospective cohort study of all hospitalized neonates and children who received dialysis for AKI across Ontario between 1996 and 2015 and survived to hospital discharge (exposed cohort). We assembled a comparator cohort (up to 4 neonates and children without AKI-D for every patient with AKI-D) matched on demographics and comorbidities. Primary outcomes were all-cause mortality and end-stage renal disease (ESRD, defined as receipt of chronic dialysis or a kidney transplant) and secondary outcomes were de novo CKD and hypertension. Incidence rates (IR) were calculated and Cox proportional hazards models were fitted for all outcomes.

Results

There were 466 neonates and 1641 children hospitalized with AKI-D in Ontario between 1996 and 2015, of whom 356 neonates and 1500 children, had matched counterparts without AKI-D. The median follow-up time was 9.2 years (Interquartile Range (IQR) 4.7,12.0) for neonates and 12.4 years (IQR 5.8,16.9) for children. After adjusting for confounders, survivors of AKI-D during the neonatal period had a 21-fold risk of death and a 7-fold higher risk of hypertension, as compared to neonates with no AKI-D. Similarly, children surviving an episode of AKI-D had a higher risk of death, CKD and hypertension as compared to hospitalized children who did not experience AKI-D. (Table 1).

Conclusion

Neonates and children with AKI-D remain at higher risk of long-term adverse outcomes compared to those without AKI-D suggesting that they need a close follow-up after discharge.

Table 1:Incident rates and hazard ratios of long-term adverse outcomes among neonates and children with AKI-D in Ontario between 1996 and 2015