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Kidney Week

Abstract: PO2259

Kidney Outcomes in Pediatric Non-Kidney Solid Organ Transplant Patients

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Patel, Mital, Duke University, Durham, North Carolina, United States
  • Joyce, Emily Lauren, UH Rainbow Babies and Children's Hospital Division of Pediatrics, Cleveland, Ohio, United States
  • Kellum, John A., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • West, Shawn C., Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United States
  • Priyanka, Priyanka, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Fuhrman, Dana Y., Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United States
Background

Acute Kidney Disease (AKD) is defined as impaired kidney function for < 90 days with or without an acute kidney injury (AKI) event. Adults with AKD have increased risk for progression to chronic kidney disease (CKD) and mortality. There are no data on the epidemiology of AKD in children after transplant. The aim of this study was to evaluate the incidence and risk factors for AKI, AKD and CKD at a large pediatric transplant center.

Methods

A retrospective chart review was done in children who underwent non-kidney solid organ transplant between 2011-2019 at UPMC Children’s Hospital of Pittsburgh. AKI and AKD are defined using the Kidney Disease Improving Global Outcomes criteria. AKD is defined as serum creatinine >/= 50% times baseline or eGFR < 60 ml/min/1.73m2 or a decrease in eGFR by >/= 35% times baseline for > 7 days and up to 3 months. Patients with a new eGFR of <60 ml/min/1.73m2 persisting for > 3 months met criteria for CKD. Variables associated with AKI, AKD and CKD were analyzed.

Results

Among 338 patients 37.9% met criteria for severe AKI, 11.5% for AKD and 8% for a new diagnosis of CKD. Stage 3 AKI was independently associated with AKD (OR: 4.10; 95% CI: 1.64-10.25). AKD but not severe AKI was associated with new onset CKD (Table 1). There was a dose dependent relationship between nephrotoxic medication use and incidence of AKD (Figure 1).

Conclusion

In conclusion, children with AKD after transplant are particularly vulnerable to developing CKD and there are modifiable risk factors that could decrease the risk of progression of AKI to AKD and CKD in this population.

Multivariable logistic regression of risk factors for CKD
CharacteristicOR (95% CI)P-value
Age (years)1.00 (0.99-1.01)0.51
Gender2.67 (1.00-7.13)0.05
Race2.55 (0.88-7.38)0.09
Severe AKI0.94 (0.38-2.30)0.89
All AKI1.58 (0.62-4.00)0.33
AKD20.45 (7.48-55.87)<0.01

Association between nephrotoxic medication use and AKD