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Trajectory of kidney recovery in pediatric patients requiring continuous kidney replacement therapy for acute kidney injury

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Abstract

Background

Acute kidney injury (AKI) is commonly seen in the PICU and is associated with poor short-term and long-term outcomes, especially in patients who required continuous kidney replacement therapy (CKRT). However, as the trajectory of kidney recovery in these patients remain uncertain, determination of the timing to convert to permanent kidney replacement therapy (KRT) remains a major challenge. We aimed to examine the frequency and timing of kidney recovery in pediatric AKI survivors that required CKRT.

Methods

We performed a retrospective study of patients under 18 years old who received CKRT for AKI in a tertiary-care PICU over 6 years. Primary outcomes were the rate of KRT withdrawal due to kidney recovery and KRT-dependent days for those who survived to hospital discharge. Secondary outcomes were all-cause mortality, dialysis dependence, and occurrences of estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73m2 and eGFR < 60 mL/min/1.73m2 one year after initiation of the index CKRT in survivors.

Results

Thirty-nine patients were included. Of the 28 children who survived to hospital discharge, 26 (93%) withdrew from dialysis due to kidney recovery, all within 30 days. Twenty-three patients were followed up. One had died, five had an eGFR of 60 mL/min/1.73m2 or more but less than 90 mL/min/1.73m2, and two had an eGFR < 60 mL/min/1.73m2, of which one required peritoneal dialysis.

Conclusions

Over 90% of the survivors withdrew CKRT within 30 days. However, the frequency of abnormal eGFR one year after initiation of CKRT in survivors exceeded 30% and supports the recommendation of post-AKI follow-up.

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Availability of data and material

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Critical Care and Anesthesia, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan

    Kaoru Tsuboi, Norihiko Tsuboi, Jun Ninagawa, Yasuyuki Suzuki & Satoshi Nakagawa

  2. Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan

    Kentaro Nishi

Authors
  1. Kaoru Tsuboi
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  2. Norihiko Tsuboi
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  3. Kentaro Nishi
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  4. Jun Ninagawa
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  5. Yasuyuki Suzuki
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  6. Satoshi Nakagawa
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Contributions

KT drafted and revised the initial manuscript; NT, KN, JN, YS, and SN critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kaoru Tsuboi.

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All the authors have declared no competing interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 2021–187) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Need for consent from individual patients was waived by the Institutional Review Board.

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Cite this article

Tsuboi, K., Tsuboi, N., Nishi, K. et al. Trajectory of kidney recovery in pediatric patients requiring continuous kidney replacement therapy for acute kidney injury. Clin Exp Nephrol 26, 1130–1136 (2022). https://doi.org/10.1007/s10157-022-02246-5

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  • DOI: https://doi.org/10.1007/s10157-022-02246-5

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