Cal H Robinson1,2, Nivethika Jeyakumar3, Bin Luo3, Ron Wald4, Amit X Garg3, Danielle M Nash3, Eric McArthur3, Jason H Greenberg5, David Askenazi6, Cherry Mammen7, Lehana Thabane2,8,9,10, Stuart Goldstein11, Rulan S Parekh1, Michael Zappitelli1, Rahul Chanchlani12,8,13. 1. Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada. 2. Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada. 3. ICES, London, Ontario, Canada. 4. Division of Nephrology, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada. 5. Division of Nephrology, Department of Pediatrics, Yale University, New Haven, Connecticut. 6. Division of Pediatric Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama. 7. Division of Nephrology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada. 8. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. 9. Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada. 10. Biostatistics Unit, St Joseph's Healthcare, Hamilton, Ontario, Canada. 11. Center for Acute Care Nephrology, Cincinnati Children's Hospital, Cincinnati, Ohio. 12. ICES, London, Ontario, Canada chanchlr@mcmaster.ca. 13. Division of Pediatric Nephrology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
Abstract
BACKGROUND: AKI is common during pediatric hospitalizations and associated with adverse short-term outcomes. However, long-term outcomes among survivors of pediatric AKI who received dialysis remain uncertain. METHODS: To determine the long-term risk of kidney failure (defined as receipt of chronic dialysis or kidney transplant) or death over a 22-year period for pediatric survivors of dialysis-treated AKI, we used province-wide health administrative databases to perform a retrospective cohort study of all neonates and children (aged 0-18 years) hospitalized in Ontario, Canada, from April 1, 1996, to March 31, 2017, who survived a dialysis-treated AKI episode. Each AKI survivor was matched to four hospitalized pediatric comparators without dialysis-treated AKI, on the basis of age, sex, and admission year. We reported the incidence of each outcome and performed Cox proportional hazards regression analyses, adjusting for relevant covariates. RESULTS: We identified 1688 pediatric dialysis-treated AKI survivors (median age 5 years) and 6752 matched comparators. Among AKI survivors, 53.7% underwent mechanical ventilation and 33.6% had cardiac surgery. During a median 9.6-year follow-up, AKI survivors were at significantly increased risk of a composite outcome of kidney failure or death versus comparators. Death occurred in 113 (6.7%) AKI survivors, 44 (2.6%) developed kidney failure, 174 (12.1%) developed hypertension, 213 (13.1%) developed CKD, and 237 (14.0%) had subsequent AKI. AKI survivors had significantly higher risks of developing CKD and hypertension versus comparators. Risks were greatest in the first year after discharge and gradually decreased over time. CONCLUSIONS: Survivors of pediatric dialysis-treated AKI are at higher long-term risks of kidney failure, death, CKD, and hypertension, compared with a matched hospitalized cohort.
BACKGROUND: AKI is common during pediatric hospitalizations and associated with adverse short-term outcomes. However, long-term outcomes among survivors of pediatric AKI who received dialysis remain uncertain. METHODS: To determine the long-term risk of kidney failure (defined as receipt of chronic dialysis or kidney transplant) or death over a 22-year period for pediatric survivors of dialysis-treated AKI, we used province-wide health administrative databases to perform a retrospective cohort study of all neonates and children (aged 0-18 years) hospitalized in Ontario, Canada, from April 1, 1996, to March 31, 2017, who survived a dialysis-treated AKI episode. Each AKI survivor was matched to four hospitalized pediatric comparators without dialysis-treated AKI, on the basis of age, sex, and admission year. We reported the incidence of each outcome and performed Cox proportional hazards regression analyses, adjusting for relevant covariates. RESULTS: We identified 1688 pediatric dialysis-treated AKI survivors (median age 5 years) and 6752 matched comparators. Among AKI survivors, 53.7% underwent mechanical ventilation and 33.6% had cardiac surgery. During a median 9.6-year follow-up, AKI survivors were at significantly increased risk of a composite outcome of kidney failure or death versus comparators. Death occurred in 113 (6.7%) AKI survivors, 44 (2.6%) developed kidney failure, 174 (12.1%) developed hypertension, 213 (13.1%) developed CKD, and 237 (14.0%) had subsequent AKI. AKI survivors had significantly higher risks of developing CKD and hypertension versus comparators. Risks were greatest in the first year after discharge and gradually decreased over time. CONCLUSIONS: Survivors of pediatric dialysis-treated AKI are at higher long-term risks of kidney failure, death, CKD, and hypertension, compared with a matched hospitalized cohort.
Authors: Chi-yuan Hsu; Raymond K Hsu; Jingrong Yang; Juan D Ordonez; Sijie Zheng; Alan S Go Journal: J Am Soc Nephrol Date: 2015-07-01 Impact factor: 10.121
Authors: Paul M Palevsky; Bruce A Molitoris; Mark D Okusa; Adeera Levin; Sushrut S Waikar; Ron Wald; Glenn M Chertow; Patrick T Murray; Chirag R Parikh; Andrew D Shaw; Alan S Go; Sarah G Faubel; John A Kellum; Vernon M Chinchilli; Kathleen D Liu; Alfred K Cheung; Steven D Weisbord; Lakhmir S Chawla; James S Kaufman; Prasad Devarajan; Robert M Toto; Chi-yuan Hsu; Tom Greene; Ravindra L Mehta; John B Stokes; Aliza M Thompson; B Taylor Thompson; Christof S Westenfelder; James A Tumlin; David G Warnock; Sudhir V Shah; Yining Xie; Emily G Duggan; Paul L Kimmel; Robert A Star Journal: Clin J Am Soc Nephrol Date: 2012-03-22 Impact factor: 8.237
Authors: Rahul Chanchlani; Danielle Marie Nash; Eric McArthur; Michael Zappitelli; Victoria Archer; John Paul Kuwornu; Amit X Garg; Jason H Greenberg; Stuart L Goldstein; Lehana Thabane; Ron Wald Journal: Clin J Am Soc Nephrol Date: 2019-08-23 Impact factor: 8.237
Authors: Allison Dart; Mariette Chartier; Paul Komenda; Randy Walld; Ina Koseva; Charles Burchill; Navdeep Tangri Journal: Pediatr Res Date: 2019-10-02 Impact factor: 3.756
Authors: Michael Zappitelli; Chirag R Parikh; James S Kaufman; Alan S Go; Paul L Kimmel; Chi-Yuan Hsu; Steven G Coca; Vernon M Chinchilli; Jason H Greenberg; Marva M Moxey-Mims; T Alp Ikizler; Vedran Cockovski; Anne-Marie Dyer; Prasad Devarajan Journal: Clin J Am Soc Nephrol Date: 2020-09-18 Impact factor: 8.237
Authors: Seth A Hollander; Maria E Montez-Rath; David M Axelrod; Catherine D Krawczeski; Lindsay J May; Katsuhide Maeda; David N Rosenthal; Scott M Sutherland Journal: Am J Kidney Dis Date: 2016-03-09 Impact factor: 8.860
Authors: Cal H Robinson; Nivethika Jeyakumar; Ron Wald; Michael Zappitelli; Rahul Chanchlani Journal: J Am Soc Nephrol Date: 2021-09-16 Impact factor: 14.978
Authors: Ron Wald; William Beaubien-Souligny; Rahul Chanchlani; Edward G Clark; Javier A Neyra; Marlies Ostermann; Samuel A Silver; Suvi Vaara; Alexander Zarbock; Sean M Bagshaw Journal: Intensive Care Med Date: 2022-09-06 Impact factor: 41.787
Authors: Michael T Hawkes; Aleksandra Leligdowicz; Anthony Batte; Geoffrey Situma; Kathleen Zhong; Sophie Namasopo; Robert O Opoka; Kevin C Kain; Andrea L Conroy Journal: Pathogens Date: 2022-04-03