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Kidney Week

Abstract: TH-PO510

Long-Term Outcomes After Pediatric Non-Dialysis-Treated AKI: A Population-Based Cohort Study

Session Information

  • Pediatric Nephrology - I
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Robinson, Cal, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Jeyakumar, Nivethika, ICES Western, London, Ontario, Canada
  • Askenazi, David J., The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Deep, Akash, King's College London, London, United Kingdom
  • Garg, Amit X., ICES Western, London, Ontario, Canada
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Greenberg, Jason Henry, Yale University, New Haven, Connecticut, United States
  • Mammen, Cherry, BC Children's Hospital, Vancouver, British Columbia, Canada
  • Nash, Danielle Marie, London Health Sciences Centre, London, Ontario, Canada
  • Parekh, Rulan S., The Hospital for Sick Children, Toronto, Ontario, Canada
  • Silver, Samuel A., Queen's University, Kingston, Ontario, Canada
  • Wald, Ron, St Michael's Hospital, Toronto, Ontario, Canada
  • Zappitelli, Michael, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Chanchlani, Rahul, McMaster Children's Hospital, Hamilton, Ontario, Canada
Background

Acute kidney injury (AKI) is common in hospitalized children. Dialysis-treated pediatric AKI is associated with long-term chronic kidney disease (CKD), hypertension, and death. We aim to evaluate the outcomes after non-dialysis-treated AKI, which are uncertain.

Methods

Retrospective cohort study of all hospitalized children (0-18yr) surviving non-dialysis-treated AKI from 1996-2020 in Ontario, identified via provincial administrative health databases. Children with prior kidney replacement therapy (KRT; dialysis or transplant), CKD, or AKI were excluded. Cases were matched with up to four hospitalized controls without AKI by age, neonatal status, sex, index year, ICU admission, cardiac surgery, malignancy, hypertension, and a propensity score for AKI. Children were followed until death (2.9%), provincial emigration (5.3%), or March 2021 (91.8%). The primary outcome was major adverse kidney events (MAKE; composite of death, chronic KRT, or de novo CKD).

Results

A total of 4173 pediatric AKI survivors were matched to 16,337 hospitalized controls. Baseline covariates were well-balanced after propensity score matching. Median age was 8yr (IQR 1-15); 706 (16.9%) AKI cases were neonates. During median 9.7-year follow-up, 17.6% of AKI survivors developed MAKE vs 4.6% of controls (HR 4.3, 95%CI 3.9-4.8, p<0.001). AKI cases had higher rates of chronic KRT (2.2% vs 0.2%; HR 12.8, 95%CI 8.5-19.4), CKD (15.9% vs 2.0%; HR 8.8, 95%CI 7.7-10.0), hypertension (16.8% vs 7.7%; HR 2.4, 95%CI 2.2-2.7), and subsequent AKI (5.7% vs 1.5%; HR 4.0, 95%CI 3.4-4.8), but no mortality difference (2.7% vs 2.9%; HR 1.0, 95%CI 0.78-1.16).

Conclusion

Children with non-dialysis-treated AKI are at increased long-term risk of CKD, chronic KRT, hypertension, and subsequent AKI vs hospitalized controls.

Figure. Cumulative incidence of MAKE

Funding

  • Private Foundation Support