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Acute kidney injury in critically ill children and 5-year hypertension

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Abstract

Background

To develop a pediatric-specific hypertension algorithm using administrative data and use it to evaluate the association between acute kidney injury (AKI) in the intensive care unit (ICU) and hypertension diagnosis 5 years post-discharge.

Methods

Two-center retrospective cohort study of children (≤ 18 years old) admitted to the pediatric ICU in Montreal, Canada, between 2003 and 2005 and followed until 2010. Patients with a valid healthcare number and without end-stage renal disease were included. Patients who could not be merged with the provincial database, did not survive admission, underwent cardiac surgery, had pre-existing renal disease associated with hypertension or a prior diagnosis of hypertension were excluded. AKI defined using the Kidney Disease: Improving Global Outcomes (KDIGO) definition. Using diagnostic codes and medications from administrative data, novel pediatric-specific hypertension definitions were designed. Both the evaluation of the prevalence of hypertension diagnosis and the association between AKI and hypertension occurred.

Results

Nineteen hundred and seventy eight patients were included (median age at admission [interquartile range] 4.3 years [1.1–11.8], 44% female, 325 (16.4%) developed AKI). Of these patients, 130 (7%) had a hypertension diagnosis 5 years after discharge. Patients with AKI had a higher prevalence of hypertension diagnosis [non-AKI: 84/1653 (5.1%) vs. AKI: 46/325 (14.2%), p < .001]. Children with AKI had a higher adjusted risk of hypertension diagnosis (hazard ratio [95% confidence interval] 2.19 [1.47–3.26]).

Conclusions

Children admitted to the ICU have a high prevalence of hypertension post-discharge and children with AKI have over two times higher risk of hypertension compared to those with no AKI.

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References

  1. Alkandari O, Eddington KA, Hyder A, Gauvin F, Ducruet T, Gottesman R, Phan V, Zappitelli M (2011) Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study. Crit Care 15:R146

    PubMed  PubMed Central  Google Scholar 

  2. Hessey E, Morissette G, Lacroix J, Perreault S, Samuel S, Dorais M, Jouvet P, Lafrance JP, LeLorier J, Phan V, Palijan A, Pizzi M, Roy L, Zappitelli M (2018) Long-term mortality after acute kidney injury in the pediatric ICU. Hosp Pediatr 8:260–268

    PubMed  Google Scholar 

  3. Hessey E, Morissette G, Lacroix J, Perreault S, Samuel S, Dorais M, Phan V, Jouvet P, Lafrance JP, LeLorier J, Palijan A, Pizzi M, Roy L, Zappitelli M (2018) Healthcare utilization after acute kidney injury in the pediatric intensive care unit. Clin J Am Soc Nephrol 13:685–692

    PubMed  PubMed Central  Google Scholar 

  4. Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL (2017) Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med 376:11–20

    PubMed  Google Scholar 

  5. Coca SG, Singanamala S, Parikh CR (2012) Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int 81:442–448

    PubMed  Google Scholar 

  6. Hsu CY, Hsu RK, Yang J, Ordonez JD, Zheng S, Go AS (2016) Elevated BP after AKI. J Am Soc Nephrol 27:914–923

    PubMed  CAS  Google Scholar 

  7. Greenberg JH, Zappitelli M, Devarajan P, Thiessen-Philbrook HR, Krawczeski C, Li S, Garg AX, Coca S, Parikh CR (2016) Kidney outcomes 5 years after pediatric cardiac surgery: the TRIBE-AKI study. JAMA Pediatr 170:1071–1078

    PubMed  PubMed Central  Google Scholar 

  8. Askenazi DJ, Feig DI, Graham NM, Hui-Stickle S, Goldstein SL (2006) 3-5 year longitudinal follow-up of pediatric patients after acute renal failure. Kidney Int 69:184–189

    PubMed  CAS  Google Scholar 

  9. Mammen C, Al Abbas A, Skippen P, Nadel H, Levine D, Collet JP, Matsell DG (2012) Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis 59:523–530

    PubMed  Google Scholar 

  10. Chen X, Wang Y (2008) Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation 117:3171–3180

    PubMed  PubMed Central  Google Scholar 

  11. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM (2017) Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140:e20171904

    PubMed  Google Scholar 

  12. Kelly RK, Thomson R, Smith KJ, Dwyer T, Venn A, Magnussen CG (2015) Factors affecting tracking of blood pressure from childhood to adulthood: the childhood determinants of adult health study. J Pediatr 167:1422–1428

    PubMed  Google Scholar 

  13. Heung M, Steffick DE, Zivin K, Gillespie BW, Banerjee T, Hsu CY, Powe NR, Pavkov ME, Williams DE, Saran R, Shahinian VB (2015) Acute kidney injury recovery pattern and subsequent risk of CKD: an analysis of veterans health administration data. Am J Kidney Dis 67:742–752

    PubMed  PubMed Central  Google Scholar 

  14. Simon TD, Cawthon ML, Stanford S, Popalisky J, Lyons D, Woodcox P, Hood M, Chen AY, Mangione-Smith R (2014) Pediatric medical complexity algorithm: a new method to stratify children by medical complexity. Pediatrics 133:e1647–e1654

    PubMed  PubMed Central  Google Scholar 

  15. Pollack MM, Ruttimann UE, Getson PR (1988) Pediatric risk of mortality (PRISM) score. Crit Care Med 16:1110–1116

    PubMed  CAS  Google Scholar 

  16. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group (2012) KDIGO clinical practice guideline for acute kidney injury. Kidney Inter Suppl 2:1–138

    Google Scholar 

  17. Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL (2007) Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 71:1028–1035

    PubMed  CAS  Google Scholar 

  18. Hessey E, Ali R, Dorais M, Morissette G, Pizzi M, Rink N, Jouvet P, Lacroix J, Phan V, Zappitelli M (2017) Evaluation of height-dependent and height-independent methods of estimating baseline serum creatinine in critically ill children. Pediatr Nephrol 32:1953–1962

    PubMed  Google Scholar 

  19. Zeng X, McMahon GM, Brunelli SM, Bates DW, Waikar SS (2014) Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals. Clin J Am Soc Nephrol 9:12–20

    PubMed  CAS  Google Scholar 

  20. Bartels CM, Johnson H, Voelker K, Thorpe C, McBride P, Jacobs EA, Pandhi N, Smith M (2014) Impact of rheumatoid arthritis on receiving a diagnosis of hypertension among patients with regular primary care. Arthritis Care Res (Hoboken) 66:1281–1288

    Google Scholar 

  21. Liu L, An Y, Chen M, Liu Z, Hu X, Chou E, Eisen HJ (2013) Trends in the prevalence of hospitalization attributable to hypertensive diseases among United States adults aged 35 and older from 1980 to 2007. Am J Cardiol 112:694–699

    PubMed  Google Scholar 

  22. Muhajarine N, Mustard C, Roos LL, Young TK, Gelskey DE (1997) Comparison of survey and physician claims data for detecting hypertension. J Clin Epidemiol 50:711–718

    PubMed  CAS  Google Scholar 

  23. Roy L, White-Guay B, Dorais M, Dragomir A, Lessard M, Perreault S (2013) Adherence to antihypertensive agents improves risk reduction of end-stage renal disease. Kidney Int 84:570–577

    PubMed  CAS  Google Scholar 

  24. Siddiqui NF, Coca SG, Devereaux PJ, Jain AK, Li L, Luo J, Parikh CR, Paterson M, Philbrook HT, Wald R, Walsh M, Whitlock R, Garg AX (2012) Secular trends in acute dialysis after elective major surgery--1995 to 2009. CMAJ 184:1237–1245

    PubMed  PubMed Central  Google Scholar 

  25. Tu K, Campbell NR, Chen ZL, Cauch-Dudek KJ, McAlister FA (2007) Accuracy of administrative databases in identifying patients with hypertension. Open Med 1:e18–e26

    PubMed  PubMed Central  Google Scholar 

  26. Wilchesky M, Tamblyn RM, Huang A (2004) Validation of diagnostic codes within medical services claims. J Clin Epidemiol 57:131–141

    PubMed  Google Scholar 

  27. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43:1130–1139

    PubMed  Google Scholar 

  28. Ronksley PE, Tonelli M, Quan H, Manns BJ, James MT, Clement FM, Samuel S, Quinn RR, Ravani P, Brar SS, Hemmelgarn BR (2012) Validating a case definition for chronic kidney disease using administrative data. Nephrol Dial Transplant 27:1826–1831

    PubMed  CAS  Google Scholar 

  29. Nelson SE, Shroff GR, Li S, Herzog CA (2012) Impact of chronic kidney disease on risk of incident atrial fibrillation and subsequent survival in medicare patients. J Am Heart Assoc 1:e002097

    PubMed  PubMed Central  Google Scholar 

  30. Navaneethan SD, Jolly SE, Schold JD, Arrigain S, Saupe W, Sharp J, Lyons J, Simon JF, Schreiber MJ Jr, Jain A, Nally JV Jr (2011) Development and validation of an electronic health record-based chronic kidney disease registry. Clin J Am Soc Nephrol 6:40–49

    PubMed  PubMed Central  Google Scholar 

  31. Perreault S, Dragomir A, Roy L, White M, Blais L, Lalonde L, Berard A (2010) Adherence level of antihypertensive agents in coronary artery disease. Br J Clin Pharmacol 69:74–84

    PubMed  PubMed Central  CAS  Google Scholar 

  32. Nerenberg KA, Zarnke KB, Leung AA, Dasgupta K, Butalia S, McBrien K, Harris KC, Nakhla M, Cloutier L, Gelfer M, Lamarre-Cliche M, Milot A, Bolli P, Tremblay G, McLean D, Padwal RS, Tran KC, Grover S, Rabkin SW, Moe GW, Howlett JG, Lindsay P, Hill MD, Sharma M, Field T, Wein TH, Shoamanesh A, Dresser GK, Hamet P, Herman RJ, Burgess E, Gryn SE, Grégoire JC, Lewanczuk R, Poirier L, Campbell TS, Feldman RD, Lavoie KL, Tsuyuki RT, Honos G, Prebtani APH, Kline G, Schiffrin EL, Don-Wauchope A, Tobe SW, Gilbert RE, Leiter LA, Jones C, Woo V, Hegele RA, Selby P, Pipe A, McFarlane PA, Oh P, Gupta M, Bacon SL, Kaczorowski J, Trudeau L, Campbell NRC, Hiremath S, Roerecke M, Arcand J, Ruzicka M, Prasad GVR, Vallée M, Edwards C, Sivapalan P, Penner SB, Fournier A, Benoit G, Feber J, Dionne J, Magee LA, Logan AG, Côté A-M, Rey E, Firoz T, Kuyper LM, Gabor JY, Townsend RR, Rabi DM, Daskalopoulou SS (2018) Hypertension Canada 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Can J Cardiol 34:506–525

    PubMed  Google Scholar 

  33. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, Initiative S (2014) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 12:1495–1499

    Google Scholar 

  34. Hessey E, Perreault S, Dorais M, Roy L, Zappitelli M (2019) Acute kidney injury in critically ill children and subsequent chronic kidney disease. Can J Kidney Health Dis 6:2054358119880188

    PubMed  PubMed Central  Google Scholar 

  35. Dionne JM, Harris KC, Benoit G, Feber J, Poirier L, Cloutier L, Nakhla M, Rabi DM, Daskalopoulou SS, Fournier A (2017) Hypertension Canada’s 2017 guidelines for the diagnosis, assessment, prevention, and treatment of pediatric hypertension. Can J Cardiol 33:577–585

    PubMed  Google Scholar 

  36. Menon S, Kirkendall ES, Nguyen H, Goldstein SL (2014) Acute kidney injury associated with high nephrotoxic medication exposure leads to chronic kidney disease after 6 months. J Pediatr 165:522–527.e522

    PubMed  CAS  Google Scholar 

  37. Cooper DS, Claes D, Goldstein SL, Bennett MR, Ma Q, Devarajan P, Krawczeski CD (2016) Follow-up renal assessment of injury long-term after acute kidney injury (FRAIL-AKI). Clin J Am Soc Nephrol 11:21–29

    PubMed  CAS  Google Scholar 

  38. Hoffmeister PA, Hingorani SR, Storer BE, Baker KS, Sanders JE (2010) Hypertension in long-term survivors of pediatric hematopoietic cell transplantation. Biol Blood Marrow Transplant 16:515–524

    PubMed  CAS  Google Scholar 

  39. Basile DP, Donohoe D, Roethe K, Osborn JL (2001) Renal ischemic injury results in permanent damage to peritubular capillaries and influences long-term function. Am J Physiol Renal Physiol 281:F887–F899

    PubMed  CAS  Google Scholar 

  40. Wuhl E, Trivelli A, Picca S, Litwin M, Peco-Antic A, Zurowska A, Testa S, Jankauskiene A, Emre S, Caldas-Afonso A, Anarat A, Niaudet P, Mir S, Bakkaloglu A, Enke B, Montini G, Wingen AM, Sallay P, Jeck N, Berg U, Caliskan S, Wygoda S, Hohbach-Hohenfellner K, Dusek J, Urasinski T, Arbeiter K, Neuhaus T, Gellermann J, Drozdz D, Fischbach M, Moller K, Wigger M, Peruzzi L, Mehls O, Schaefer F (2009) Strict blood-pressure control and progression of renal failure in children. N Engl J Med 361:1639–1650

    PubMed  Google Scholar 

  41. Heneghan JA, Pollack MM (2017) Morbidity: changing the outcome paradigm for pediatric critical care. Pediatr Clin N Am 64:1147–1165

    Google Scholar 

  42. Ministère de l’Immigration, de la Diversité et de l’Inclusion (2014) Recueil de statistiques sur l’immigration et la diversité au Québec. Gouvernement du Québec, Montreal, pp 1–58

    Google Scholar 

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Acknowledgments

We acknowledge the individuals who performed the data collection and helped with data management at Hospital Sainte Justine and the Montreal Children’s Hospital. We acknowledge Vedran Cockovski, for helping with manuscript preparation and submission. Michael Zappitelli received research support from Fonds de Recherche du Québec Santé, which allowed him to perform this work.

Funding

All phases of this study were supported by Fonds de Recherche du Québec—Santé (FRQS) (grant number 22888 [to MZ]). MZ was supported by a research salary award and EH by a graduate studies award from the FRQS.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Nephrology, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Québec, Canada

    Erin Hessey & Michael Zappitelli

  2. Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada

    Erin Hessey

  3. Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada

    Sylvie Perreault

  4. Department of Medicine, Division of Nephrology, Université de Montréal, Montreal, Québec, Canada

    Louise Roy

  5. StatSciences Inc, Notre-Dame-de-l’Île-Perrot, Québec, Canada

    Marc Dorais

  6. Department of Pediatrics, Division of Nephrology, Alberta Children’s Hospital, Calgary, Alberta, Canada

    Susan Samuel

  7. Department of Pediatrics, Division of Nephrology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada

    Véronique Phan

  8. Department of Medicine, Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada

    Jean-Philippe Lafrance

  9. Department of Pharmacology and Physiology, Université de Montréal, Montreal, Québec, Canada

    Jean-Philippe Lafrance

  10. Department of Pediatrics, Division of Nephrology, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 6th floor, Room 06.9708, Toronto, ON, M5G 0A4, Canada

    Michael Zappitelli

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  1. Erin Hessey
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  2. Sylvie Perreault
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  3. Louise Roy
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  5. Susan Samuel
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Corresponding author

Correspondence to Michael Zappitelli.

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Approvals from institutional research ethics boards from both centres and the Commission d’accès à l’information du Québec (CAI, provincial ethics body) were obtained.

Conflict of interest

The authors have no conflicts of interest to declare. Funding was given by a government grant agency that had no involvement in study design, collection, analysis, and interpretation of data, manuscript writing, or submission. EH wrote the initial draft of the manuscript and did not receive an honorarium, grant, or other form of payment to produce the manuscript.

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Hessey, E., Perreault, S., Roy, L. et al. Acute kidney injury in critically ill children and 5-year hypertension. Pediatr Nephrol 35, 1097–1107 (2020). https://doi.org/10.1007/s00467-020-04488-5

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