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Patient level factors increase risk of acute kidney disease in hospitalized children with acute kidney injury

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Abstract

Background

Studies in adults have shown that persistent kidney dysfunction ≥7–90 days following acute kidney injury (AKI), termed acute kidney disease (AKD), increases chronic kidney disease (CKD) and mortality risk. Little is known about the factors associated with the transition of AKI to AKD and the impact of AKD on outcomes in children. The aim of this study is to evaluate risk factors for progression of AKI to AKD in hospitalized children and to determine if AKD is a risk factor for CKD.

Methods

Retrospective cohort study of children age ≤18 years admitted with AKI to all pediatric units at a single tertiary-care children’s hospital between 2015 and 2019. Exclusion criteria included insufficient serum creatinine values to evaluate for AKD, chronic dialysis, or previous kidney transplant.

Results

A total of 528 children with AKI were included in the study. There were 297 (56.3%) hospitalized AKI survivors who developed AKD. Among children with AKD, 45.5% developed CKD compared to 18.7% in the group without AKD (OR 4.0, 95% CI 2.1–7.4, p-value <0.001 using multivariable logistic regression analysis including other covariates). Multivariable logistic regression model identified age at AKI diagnosis, PCICU and NICU admission, prematurity, malignancy, bone marrow transplant, previous AKI, mechanical ventilation, AKI stage, duration of kidney injury, and need for kidney replacement therapy during day 1–7 as risk factors for AKD after AKI.

Conclusions

AKD is common among hospitalized children with AKI and multiple risk factors are associated with AKD. Children that progress from AKI to AKD are at higher risk of developing CKD.

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Data availability

All data are stored according to the Duke University Institutional Review Board approval and are available upon request.

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Funding

MP was supported by National Institutes of Health Nephrology Training Grant (5T32DK007731-24).

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics, Duke University, Durham, NC, USA

    Mital Patel & Rasheed Gbadegesin

  2. Division of Critical Care Medicine, Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC, USA

    Christoph Hornik

  3. Division of Nephrology, Department of Medicine, Duke University, Durham, NC, USA

    Clarissa Diamantidis

  4. Division of Pediatric Nephrology, Department of Pediatrics, Medical University of South Carolina Charleston, Charleston, SC, USA

    David T Selewski

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  1. Mital Patel
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  5. Rasheed Gbadegesin
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Contributions

MP, CH, CD, DS, and RG designed the study. MP gathered clinical data for the study. MP and CH carried out the data analysis. MP wrote the manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Mital Patel.

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Ethics approval

The study was approved by the Duke University Institutional Review Board.

Competing interests

CJD reports consultancy with UnitedHealth Group/Optum Labs. Other authors have no relevant financial or non-financial interests to disclose.

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Patel, M., Hornik, C., Diamantidis, C. et al. Patient level factors increase risk of acute kidney disease in hospitalized children with acute kidney injury. Pediatr Nephrol 38, 3465–3474 (2023). https://doi.org/10.1007/s00467-023-05997-9

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  • DOI: https://doi.org/10.1007/s00467-023-05997-9

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