Kelly Benisty1, Catherine Morgan2, Erin Hessey3, Louis Huynh4, Ari R Joffe5, Daniel Garros5, Adrian Dancea6, Reginald Sauve7, Ana Palijan8, Michael Pizzi8, Sudeshna Bhattacharya2, Julie Ann Doucet8, Vedran Cockovski9, Ronald G Gottesman10, Stuart L Goldstein11, Michael Zappitelli12,13. 1. Faculty of Medicine, McGill University, Montreal, QC, Canada. 2. Department of Pediatrics, Division of Nephrology, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada. 3. Faculty of Medicine, University of Alberta, Edmonton, AB, Canada. 4. Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, ON, Canada. 5. Department of Pediatrics, Division of Pediatric Critical Care, University of Alberta, Edmonton, AB, Canada. 6. Department of Pediatrics, Division of Cardiology, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada. 7. Department of Pediatrics and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. 8. McGill University Health Centre Research Institute, McGill University Health Centre, Montreal, QC, Canada. 9. Department of Pediatrics, Division of Nephrology, Toronto Hospital for Sick Children, Toronto, ON, Canada. 10. Department of Pediatrics, Division of Critical Care Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada. 11. Division of Nephrology and Hypertension, Center for Acute Care Nephrology, Heart Institute Research Core, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 12. Formerly, McGill University Health Centre Research Institute, McGill University Health Centre, Montreal, QC, Canada. michael.zappitelli@sickkids.ca. 13. Department of Pediatrics, Division of Nephrology, Toronto Hospital for Sick Children, Toronto, ON, Canada. michael.zappitelli@sickkids.ca.
Abstract
BACKGROUND: Acute kidney injury (AKI) in pediatric intensive care unit (PICU) children may be associated with long-term chronic kidney disease or hypertension. OBJECTIVES: To estimate (1) prevalence of kidney abnormalities (low estimated glomerular filtration rate (eGFR) or albuminuria) and blood pressure (BP) consistent with pre-hypertension or hypertension, 6 years after PICU admission; (2) if AKI is associated with these outcomes. METHODS: Longitudinal study of children admitted to two Canadian PICUs (January 2005-December 2011). Exposures (retrospective): AKI or stage 2/3 AKI (KDIGO creatinine-based definition) during PICU. Primary outcome (single visit 6 years after admission): presence of (a) low eGFR (<90 ml/min/1.73 m2) or albuminuria (albumin to creatinine ratio >30 mg/g) (termed "CKD signs") or (b) BP consistent with ≥pre-hypertension (≥90th percentile) or hypertension (≥95th percentile). RESULTS: Of 277 children, 25% had AKI. AKI and stage 2/3 AKI were associated with 2.2- and 6.6-fold higher adjusted odds, respectively, for the 6-year outcomes. Applying new hypertension guidelines attenuated associations; stage 2/3 AKI was associated with 4.5-fold higher adjusted odds for 6-year CKD signs or ≥elevated BP. CONCLUSIONS: Kidney and BP abnormalities are common 6 years after PICU admission and associated with AKI. Other risk factors must be elucidated to develop follow-up recommendations and reduce cardiovascular risk.
BACKGROUND:Acute kidney injury (AKI) in pediatric intensive care unit (PICU) children may be associated with long-term chronic kidney disease or hypertension. OBJECTIVES: To estimate (1) prevalence of kidney abnormalities (low estimated glomerular filtration rate (eGFR) or albuminuria) and blood pressure (BP) consistent with pre-hypertension or hypertension, 6 years after PICU admission; (2) if AKI is associated with these outcomes. METHODS: Longitudinal study of children admitted to two Canadian PICUs (January 2005-December 2011). Exposures (retrospective): AKI or stage 2/3 AKI (KDIGO creatinine-based definition) during PICU. Primary outcome (single visit 6 years after admission): presence of (a) low eGFR (<90 ml/min/1.73 m2) or albuminuria (albumin to creatinine ratio >30 mg/g) (termed "CKD signs") or (b) BP consistent with ≥pre-hypertension (≥90th percentile) or hypertension (≥95th percentile). RESULTS: Of 277 children, 25% had AKI. AKI and stage 2/3 AKI were associated with 2.2- and 6.6-fold higher adjusted odds, respectively, for the 6-year outcomes. Applying new hypertension guidelines attenuated associations; stage 2/3 AKI was associated with 4.5-fold higher adjusted odds for 6-year CKD signs or ≥elevated BP. CONCLUSIONS: Kidney and BP abnormalities are common 6 years after PICU admission and associated with AKI. Other risk factors must be elucidated to develop follow-up recommendations and reduce cardiovascular risk.
Authors: Amrit Kirpalani; Charushree Prasad; Natasha A Jawa; Adelle R Atkinson; Mark Feldman; Justin M Jeffers; Damien G Noone Journal: Paediatr Child Health Date: 2021-11-30 Impact factor: 2.600
Authors: Yan Sun; Sinan Gao; Xingqiang Wang; Lixin Yu; Min Xu; Wei Gao; Chao Sun; Bing Wang Journal: Front Pediatr Date: 2022-06-22 Impact factor: 3.569
Authors: Erin Hessey; Alex Paun; Kelly Benisty; Kelly McMahon; Ana Palijan; Michael Pizzi; Catherine Morgan; Michael Zappitelli Journal: Pediatr Nephrol Date: 2022-01-17 Impact factor: 3.651
Authors: Alexandra Franiek; Atul Sharma; Vedran Cockovski; David S Wishart; Michael Zappitelli; Tom D Blydt-Hansen Journal: Pediatr Nephrol Date: 2022-01-10 Impact factor: 3.651
Authors: Cal H Robinson; Nivethika Jeyakumar; Bin Luo; Ron Wald; Amit X Garg; Danielle M Nash; Eric McArthur; Jason H Greenberg; David Askenazi; Cherry Mammen; Lehana Thabane; Stuart Goldstein; Rulan S Parekh; Michael Zappitelli; Rahul Chanchlani Journal: J Am Soc Nephrol Date: 2021-05-26 Impact factor: 14.978
Authors: Erin Hessey; Nabil Melhem; Rashid Alobaidi; Emma Ulrich; Catherine Morgan; Sean M Bagshaw; Manish D Sinha Journal: Front Pediatr Date: 2021-03-15 Impact factor: 3.418
Authors: Emma H Ulrich; Erin Hessey; Sylvie Perreault; Marc Dorais; Philippe Jouvet; Veronique Phan; Michael Zappitelli Journal: Crit Care Explor Date: 2022-01-18