Kidney Week

Abstract: TH-PO1201

AKI and Long-Term Risk of Kidney Function Decline in Children with CKD

Session Information

• Pediatric Nephrology: CV Health, CKD, AKI, Dialysis, Transplantation, and Health Services Research
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1800 Pediatric Nephrology

Authors

• Roem, Jennifer, Johns Hopkins University, Baltimore, Maryland, United States

Jennifer Roem, MS

• Kisselburgh, Hannah, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Hannah Kisselburgh, PhD, RN

• Abraham, Alison G., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Alison G. Abraham, PhD

• Hanken-Arlen, Olyvia J., Yale School of Medicine, New Haven, Connecticut, United States

Olyvia J. Hanken-Arlen

• Derwick, Hannah C., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Hannah C. Derwick, MPH

• Askenazi, David J., University of Alabama at Birmingham Health System, Birmingham, Alabama, United States

David J. Askenazi, MD, MS, FASN

• Atkinson, Meredith A., Johns Hopkins University, Baltimore, Maryland, United States

Meredith A. Atkinson, MD, MS

• Denburg, Michelle, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Michelle Denburg, MD

• Modi, Zubin J., University of Michigan, Ann Arbor, Michigan, United States

Zubin J. Modi, MD, MS

• Blydt-Hansen, Tom D., The University of British Columbia, Vancouver, British Columbia, Canada

Tom D. Blydt-Hansen, MD

• Bonventre, Joseph V., Harvard University, Cambridge, Massachusetts, United States

Joseph V. Bonventre, MD, PhD, FASN

• Wilson, Francis Perry, Yale School of Medicine, New Haven, Connecticut, United States

Francis Perry Wilson, MD, MS

• Nugent, James, Yale School of Medicine, New Haven, Connecticut, United States

James Nugent, MD, MPH

• Warady, Bradley A., Children's Mercy Kansas City, Kansas City, Missouri, United States

Bradley A. Warady, MD

• Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States

Chirag R. Parikh, MD, PhD, FASN

• Furth, Susan L., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Susan L. Furth, MD, PhD

• Ng, Derek K., Johns Hopkins University, Baltimore, Maryland, United States

Derek K. Ng, PhD

• Greenberg, Jason Henry, Yale School of Medicine, New Haven, Connecticut, United States

Jason Henry Greenberg, MD

Group or Team Name

• CKiD Study Investigators

Background

AKI is common in children with CKD and may predispose to a permanent loss in kidney function. However, long-term kidney function data after AKI in pediatric CKD is limited. We evaluated whether AKI is associated with faster kidney function decline in the CKD in Children (CKiD) study.

Methods

Using a nested matched cohort design, 264 CKiD participants (132 with AKI and 132 without AKI) were included for analysis. AKI was defined as a ≥0.3 increase of serum creatinine (SCr) within 48 hours or SCr doubling using longitudinal clinical data from electronic health records, with adjudication to minimize misclassification. Participants with and without AKI were matched 1:1 on glomerular vs non-glomerular diagnosis, U25eGFR (±5 ml/min/1.73m2), urine protein-to-creatinine ratio (uPCr; 0-0.2, >0.2-2, >2 mg/g), and age (±3 years) at the closest pre-AKI research visit. Centralized measures of eGFR from annual research visits were modeled with a linear mixed-effects model to assess differences in kidney function trajectories.

Results

Overall, median age was 12 [IQR: 7, 15] years, 64% were male, median eGFR was 41 [38, 43] mL/min/1.73m2, median uPCr was 0.5 [0.2, 1.3] mg/mg, and 28% had a glomerular diagnosis. Children who developed AKI had similar baseline characteristics compared with those without AKI. Time between the pre-AKI research visit and AKI was 0.5 [0.3, 0.9] years. AKI and non-AKI participants had similar pre-AKI eGFR between groups (40 vs. 42 mL/min/1.73m2, p=0.226). Over the follow-up period, AKI participants had significantly faster eGFR decline (Figure): annual percent change in eGFR was −13.1% (95% CI: −15.2, −11.0) in AKI participants compared to −7.3% (95% CI: −9.5, −5.1) in those without AKI (p<0.001). AKI was also associated with higher rates of chronic kidney replacement therapy (55% vs. 40%) and higher mortality (4% vs. 2%).

Conclusion

Among children with CKD, AKI was associated with a faster long-term decline in kidney function compared to matched participants without AKI. Our research highlights the importance of preventing AKI and the need for interventional studies to improve outcomes post-AKI.

Funding

• NIDDK Support