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Abstract: SA-PO598

Patient Level Factors Increase Risk of Acute Kidney Disease in Hospitalized Children With AKI

Session Information

  • Pediatric Nephrology - II
    November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1800 Pediatric Nephrology

Authors

  • Patel, Mital, Duke University Medical Center, Durham, North Carolina, United States
  • Hornik, Christoph, Duke University Medical Center, Durham, North Carolina, United States
  • Diamantidis, Clarissa Jonas, Duke University Medical Center, Durham, North Carolina, United States
  • Selewski, David T., Medical University of South Carolina, Charleston, South Carolina, United States
  • Gbadegesin, Rasheed A., Duke University Medical Center, Durham, North Carolina, United States
Background

Studies in adults have shown that acute kidney disease (AKD [kidney dysfunction ≥7-90 days]) may be a better predictor of chronic kidney disease (CKD) and mortality in AKI survivors. However, in the pediatric population, little attention has been paid to the AKI-to-AKD transition and subsequent consequences. The aim of this study is to evaluate the risk factors for progression of AKI to AKD in hospitalized children and determine the incidence of CKD following AKD.

Methods

We quantified AKD risk using a retrospective cohort of 528 children admitted with AKI to critical care and general wards at a tertiary care children’s hospital between 2015-2019. Exclusion criteria included insufficient creatinine values to evaluate for AKD, chronic dialysis, or previous kidney transplant. AKI and AKD were defined using Kidney Disease Improving Global Outcomes criteria. CKD was defined as new estimated glomerular filtration rate of < 60 ml/min/1.73m2 for >3 months after AKI.

Results

In this cohort, 297 (56.3%) of hospitalized AKI survivors developed AKD. Univariable analysis showed that there are patient level risk factors for AKD (table 1) including preexisting conditions, iatrogenic factors, and severity of kidney injury. Among children with AKD, 26.3% developed CKD compared to 13.4% in the group without AKD (OR 2.9, 95% CI 1.75-4.77).

Conclusion

Our data shows that AKD is extremely common among hospitalized children with AKI and that multiple patient level risk factors are associated with AKD. This study suggests that AKI survivors with AKD are at higher risk of developing CKD than those without AKD, suggesting nephrology follow up is indicated in this group.

Table 1: Univariable analysis comparing risk factors in patients with and without AKD
VariableAKD (n=297)No AKD (n=231)p-value
Prematurity < 36 weeks106 (35.7)54 (23.4)0.0026
Malignancy37 (12.5)15 (6.5)0.023
Bone marrow transplant40 (13.5)8 (3.5)7.28e-5
Previous AKI39 (13.1)16 (6.9)0.021
Severe AKI258 (86.9)164 (70.1)6.27e-6
Mechanical ventilation152 (51.2)75 (32.5)1.65e-5
ECMO26 (8.8)10 (4.3)0.045
Nephrotoxic medication exposure261 (87.9)176 (76.2)0.00042
Supratherapeutic medications99 (33.3)55 (23.8)0.017
Sepsis175 (58.9)100 (43.3)0.00036

Data expressed as N (%)

Funding

  • NIDDK Support