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Pattern and prognostic factors for kidney function progression in survivors of children with acute kidney injury: a cohort study
  1. Wun Fung Hui1,
  2. Vivian Pui Ying Chan2,
  3. Wing Lum Cheung1,
  4. Shu Wing Ku1,
  5. Kam Lun Hon1
  1. 1 Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong
  2. 2 Department of Pharmacy, Hong Kong Children's Hospital, Kowloon, Hong Kong
  1. Correspondence to Dr Wun Fung Hui, Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong, Hong Kong; huiwf{at}ha.org.hk

Abstract

Objective To examine the pattern of kidney function progression after acute kidney injury (AKI) and identify the associated risk factors.

Design A prospective cohort study was conducted from June 2020 to June 2021 on children aged 1 month to <18 years admitted to the paediatric intensive care unit (PICU). Acute kidney disease (AKD) was defined as AKI persisting from 7 to 90 days after diagnosis. The natural history and prognostic factors of kidney function progression were determined.

Results Among the 253 admissions with a median (IQR) age of 4.9 (9.7) years, the AKI and AKD incidence was 41.9% and 52.2% respectively. The incidence of estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2 was 6.7% at 90 days and 11.9% at latest follow-up. Severe and prolonged AKI and higher degree of nephrotoxic medication exposure were associated with AKD development. The severity and duration of AKI and AKD significantly predicted kidney function non-recovery. Children with both entities exhibited a higher peak-to-baseline serum creatinine level ratio at 90 days (1.6 vs 1.0, p<0.001), and a more pronounced decline in eGFR (21% vs 19%, p=0.028) during the follow-up period compared with those without AKI/AKD. They also had an increased risk of having eGFR <90 mL/min/1.73 m2 at 90 days (HR 14.9 (95% CI 1.8 to 124.0)) and latest follow-up (HR 3.8 (95% CI 1.1 to 13.1)).

Conclusions AKI and AKD are prevalent among critically ill children and pose substantial risk for non-recovery of kidney function among PICU survivors. A structural follow-up visit for AKI survivors to monitor kidney function progression is advocated.

  • nephrology
  • intensive care units, paediatric
  • paediatrics
  • epidemiology

Data availability statement

Data are available on reasonable request. The dataset generated for this publication is available from the corresponding author on reasonable request.

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Data availability statement

Data are available on reasonable request. The dataset generated for this publication is available from the corresponding author on reasonable request.

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Footnotes

  • Contributors Research idea and study design: WFH, VPYC; data acquisition: WFH, VPYC; data analysis and manuscript drafting: WFH; clinical management: WFH, WLC, VPYC, SWK, KLH; supervision: SWK, KLH; manuscript review and approval: WLC, VPYC, SWK, KLH. Guarantor: WFH

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.