Skip to main content
SpringerLink
Log in

Major adverse kidney events after acute kidney injury in the pediatric intensive care unit: a propensity score–matched cohort study

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Acute kidney injury (AKI) in patients admitted to the pediatric intensive care unit (PICU) is associated with poor short-term and long-term outcomes. Greater awareness of long-term AKI-associated outcomes is needed to optimally plan follow-up and management after ICU discharge. We used propensity score methods to study associations between pediatric AKI and major adverse kidney outcomes, including mortality.

Methods

We included all children 6 months–18 years admitted to PICU at Seattle Children’s Hospital from 7/1/2009 to 12/31/2018. Our primary outcome measure was Major Adverse Kidney Events at 30 days (MAKE30): creatinine > 200% of baseline, eGFR < 60 mL/min/1.73 m2, dialysis dependence, or mortality. Propensity scores for AKI development in PICU were generated using demographic, medical history, admission, and PICU hospitalization variables. Patients with AKI were matched to control patients without AKI. Logistic regression was used to test association between AKI status and MAKE30.

Results

In the unmatched cohort (n = 878), patients with AKI had lower platelet count (160 vs. 222) and higher PRISM III score (11 vs. 3.5). After propensity score matching, those with AKI vs. no AKI had similar PRISM III scores (9 vs. 10) and platelet count (163 vs. 159). AKI was significantly associated with MAKE30 after propensity score matching (OR: 2.97; 95% CI 1.82–4.84).

Conclusions

Propensity score matching significantly reduced imbalance in baseline characteristics between those with and without AKI. After matching, AKI remained significantly associated with MAKE30. Patients who developed AKI were more likely to have abnormal kidney function at 30 and 90 days after ICU admission and may be at high risk for developing CKD in the future.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

Upon request, may be subject to IRB approval by the Seattle Children’s Research Institute.

Code availability

Upon request.

References

  1. Lameire N, Van Biesen W, Vanholder R (2017) Epidemiology of acute kidney injury in children worldwide, including developing countries. Pediatr Nephrol 32:1301–1314

    Article  Google Scholar 

  2. Sutherland SM, Byrnes JJ, Kothari M, Longhurst CA, Dutta S, Garcia P, Goldstein SL (2015) AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions. Clin J Am Soc Nephrol 10:554–561

    Article  Google Scholar 

  3. 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

    Article  Google Scholar 

  4. Sanchez-Pinto LN, Goldstein SL, Schneider JB, Khemani RG (2015) Association between progression and improvement of acute kidney injury and mortality in critically ill children*. Pediatr Crit Care Med 16:703–710

    Article  Google Scholar 

  5. Palevsky PM, Molitoris BA, Okusa MD, Levin A, Waikar SS, Wald R, Chertow GM, Murray PT, Parikh CR, Shaw AD, Go AS, Faubel SG, Kellum JA, Chinchilli VM, Liu KD, Cheung AK, Weisbord SD, Chawla LS, Kaufman JS, Devarajan P, Toto RM, Hsu CY, Greene T, Mehta RL, Stokes JB, Thompson AM, Thompson BT, Westenfelder CS, Tumlin JA, Warnock DG, Shah SV, Xie Y, Duggan EG, Kimmel PL, Star RA (2012) Design of clinical trials in acute kidney injury: report from an NIDDK workshop on trial methodology. Clin J Am Soc Nephrol 7:844–850

    Article  Google Scholar 

  6. Billings FT 4th, Shaw AD (2014) Clinical trial endpoints in acute kidney injury. Nephron Clin Pract 127:89–93

    Article  CAS  Google Scholar 

  7. Weiss SL, Balamuth F, Thurm CW, Downes KJ, Fitzgerald JC, Laskin BL (2019) Major adverse kidney events in pediatric sepsis. Clin J Am Soc Nephrol 14:664–672

    Article  Google Scholar 

  8. McCoy IE, Chertow GM (2020) AKI—a relevant safety end point? Am J Kidney Dis 75:508–512

    Article  CAS  Google Scholar 

  9. McMurry TL, Hu Y, Blackstone EH, Kozower BD (2015) Propensity scores: methods, considerations, and applications in the Journal of Thoracic and Cardiovascular Surgery. J Thorac Cardiovasc Surg 150:14–19

    Article  Google Scholar 

  10. Menon S, Goldstein SL, Mottes T, Fei L, Kaddourah A, Terrell T, Arnold P, Bennett MR, Basu RK (2016) Urinary biomarker incorporation into the renal angina index early in intensive care unit admission optimizes acute kidney injury prediction in critically ill children: a prospective cohort study. Nephrol Dial Transplant 31:586–594

    Article  CAS  Google Scholar 

  11. Khwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clinical Pract 120:c179–c184

    Article  Google Scholar 

  12. Austin PC, Laupacis A (2011) A tutorial on methods to estimating clinically and policy-meaningful measures of treatment effects in prospective observational studies: a review. Int J Biostat 7:0000102202155746791285

    Article  Google Scholar 

  13. Selewski DT, Charlton JR, Jetton JG, Guillet R, Mhanna MJ, Askenazi DJ, Kent AL (2015) Neonatal acute kidney injury. Pediatrics 136:e463-473

    Article  Google Scholar 

  14. Sutherland SM, Kwiatkowski DM (2017) Acute kidney injury in children. Adv Chronic Kidney Dis 24:380–387

    Article  Google Scholar 

  15. Austin PC (2009) Some methods of propensity-score matching had superior performance to others: results of an empirical investigation and Monte Carlo simulations. Biom J 51:171–184

    Article  Google Scholar 

  16. Austin PC (2011) Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat 10:150–161

    Article  Google Scholar 

  17. Hsu C-y, Chinchilli VM, Coca S, Devarajan P, Ghahramani N, Go AS, Hsu RK, Ikizler TA, Kaufman J, Liu KD, Parikh CR, Reeves WB, Wurfel M, Zappitelli M, Kimmel PL, Siew ED, ASSESS-AKI Investigators (2020) Post-Acute kidney injury proteinuria and subsequent kidney disease progression: the Assessment, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) Study. JAMA Intern Med 180:402–410

  18. Selewski DT, Hyatt DM, Bennett KM, Charlton JR (2018) Is acute kidney injury a harbinger for chronic kidney disease? Curr Opin Pediatr 30:236–240

    Article  Google Scholar 

  19. Goldstein SL, Devarajan P (2008) Progression from acute kidney injury to chronic kidney disease: a pediatric perspective. Adv Chronic Kidney Dis 15:278–283

    Article  Google Scholar 

  20. Jetton JG, Boohaker LJ, Sethi SK, Wazir S, Rohatgi S, Soranno DE, Chishti AS, Woroniecki R, Mammen C, Swanson JR, Sridhar S, Wong CS, Kupferman JC, Griffin RL, Askenazi DJ, Selewski DT, Sarkar S, Kent A, Fletcher J, Abitbol CL, DeFreitas M, Duara S, Charlton JR, Guillet R, D’Angio C, Mian A, Rademacher E, Mhanna MJ, Raina R, Kumar D, Ambalavanan N, Arikan AA, Rhee CJ, Goldstein SL, Nathan AT, Bhutada A, Rastogi S, Bonachea E, Ingraham S, Mahan J, Nada A, Brophy PD, Colaizy TT, Klein JM, Cole FS, Davis TK, Dower J, Milner L, Smith A, Fuloria M, Reidy K, Kaskel FJ, Gien J, Gist KM, Hanna MH, Hingorani S, Starr M, Joseph C, DuPont T, Ohls R, Staples A, Khokhar S, Perazzo S, Ray PE, Revenis M, Synnes A, Wintermark P (2017) Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health 1:184–194

    Article  Google Scholar 

  21. Austin PC (2007) The performance of different propensity score methods for estimating marginal odds ratios. Stat Med 26:3078–3094

    Article  Google Scholar 

  22. Greenland S (1987) Interpretation and choice of effect measures in epidemiologic analyses. Am J Epidemiol 125:761–768

    Article  CAS  Google Scholar 

  23. Sandokji I, Yamamoto Y, Biswas A, Arora T, Ugwuowo U, Simonov M, Saran I, Martin M, Testani JM, Mansour S, Moledina DG, Greenberg JH, Wilson FP (2020) A time-updated, parsimonious model to predict AKI in hospitalized children. J Am Soc Nephrol 31:1348

    Article  Google Scholar 

  24. Ugwuowo U, Yamamoto Y, Arora T, Saran I, Partridge C, Biswas A, Martin M, Moledina DG, Greenberg JH, Simonov M, Mansour SG, Vela R, Testani JM, Rao V, Rentfro K, Obeid W, Parikh CR, Wilson FP (2020) Real-time prediction of acute kidney injury in hospitalized adults: implementation and proof of concept. Am J Kidney Dis 76:806-814.e1

    Article  CAS  Google Scholar 

Download references

Funding

This work was funded by an internal grant through the Center for Clinical and Translational Research at the Seattle Children’s Research Institute. Additionally, this work was supported by Seattle Children’s Hospital/University of Washington NIH T32DK997662.

Author information

Authors and Affiliations

  1. Division of Pediatric Nephrology, Seattle Children’s Hospital, University of Washington, 4800 Sand Point Way NE, Seattle, WA, USA

    Alexander J. Kula, Jodi M. Smith & Shina Menon

  2. Biostatistics Epidemiology and Analytics in Research Core, Seattle Children’s Research Institute, Seattle, WA, USA

    Pingping Qu & Bryan Strub

Authors
  1. Alexander J. Kula
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pingping Qu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bryan Strub
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jodi M. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shina Menon
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AJK and SM developed concept, with additional guidance from JMS. BS procured and managed study data. PQ, AJK, and SM participated in statistical analysis. AJK, PQ, BS, JMS, and SM were involved in constructing, drafting, and editing of manuscript. All authors approved submission of final manuscript.

Corresponding author

Correspondence to Alexander J. Kula.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PPTX 182 KB)

Supplementary file2 (DOCX 26 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kula, A.J., Qu, P., Strub, B. et al. Major adverse kidney events after acute kidney injury in the pediatric intensive care unit: a propensity score–matched cohort study. Pediatr Nephrol 37, 2099–2107 (2022). https://doi.org/10.1007/s00467-021-05348-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-021-05348-6

Keywords

Search

Navigation