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Abstract: TH-OR112

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

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Chanchlani, Rahul, McMaster Children Hospital, Hamilton, Ontario, Canada
  • Nash, Danielle Marie, London Health Sciences Centre, London, Ontario, Canada
  • McArthur, Eric, Institute for Clinical Evaluative Sciences, London, Ontario, Canada
  • Zappitelli, Michael, Toronto Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  • Kuwornu, John paul, Government of Saskatchewan, Regina, Saskatchewan, Canada
  • Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
  • Greenberg, Jason Henry, Yale University, New Haven, Connecticut, United States
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Wald, Ron, St. Michael's Hospital, Toronto, Ontario, Canada
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