Kidney Week

Abstract: PO2259

Kidney Outcomes in Pediatric Non-Kidney Solid Organ Transplant Patients

Session Information

• CKD: Associations and Electrolytes
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

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

Authors

• Patel, Mital, Duke University, Durham, North Carolina, United States

Mital Patel, MD

• Joyce, Emily Lauren, UH Rainbow Babies and Children's Hospital Division of Pediatrics, Cleveland, Ohio, United States

Emily Lauren Joyce,

• Kellum, John A., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

John A. Kellum,

• West, Shawn C., Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United States

Shawn C. West,

• Priyanka, Priyanka, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

Priyanka Priyanka,

• Fuhrman, Dana Y., Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United States

Dana Y. Fuhrman,

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

Association between nephrotoxic medication use and AKD