Skip to main content

Advertisement

SpringerLink
Log in

Long-term kidney outcomes in children following continuous kidney replacement therapy

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

Abstract

Background

Continuous kidney replacement therapy (CKRT) is a mainstay of therapy for management of severe acute kidney injury (AKI) in critically ill pediatric patients. There is limited data on the risk of chronic kidney disease (CKD) after discharge in this population.

Methods

This is a single-center, retrospective cohort study of all pediatric patients ages 0–17 years who received CKRT from 2013 to 2017. The study excluded patients with pre-existing CKD, those who died prior to discharge, and those who had insufficient follow-up data. Patients were followed after hospital discharge and electronic health record data was collected and analyzed to assess for incidence of and risk factors for kidney sequelae.

Results

A total of 42 patients were followed at a median time of 27 months (IQR 17.2, 39.8). Of these, 26.2% had evidence of CKD and 19% were at risk for CKD. Lower eGFR at hospital discharge was associated with increased odds of kidney sequelae (aOR 0.985; 95% CI 0.972, 0.996). Ages 0– < 1 and 12–17 were not significantly different (aOR 0.235, 95% CI 0.024, 1.718) and had the highest incidence of kidney sequelae (50% and 77%, respectively). Ages 1–5 and 6–11 had a decreased odds of kidney sequelae compared to the 12–17 year age group (aOR 0.098; 95% CI 0.009, 0.703 and aOR 0.035; 95% CI 0.001, 0.39, respectively). Only 54.8% of patients (n = 23) were seen in the nephrology clinic after discharge.

Conclusions

Patients who receive CKRT for AKI have a significant risk of CKD, while follow-up with a pediatric nephrologist in these high-risk patients is sub-optimal.

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
Fig. 4

Similar content being viewed by others

Data availability

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

Code availability

Analyses were performed using R version 4.1.0 within RStudio version 1.4.1717. R Core Team (2021). R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/.

References

  1. Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL, AWARE Investigators (2016) Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med 376:11–20. https://doi.org/10.1056/NEJMoa1611391

    Article  Google Scholar 

  2. 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, Neonatal kidney collaborative (NKC) (2017) incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health 1:184–194. https://doi.org/10.1016/S2352-4642(17)30069-X

    Article  Google Scholar 

  3. Madsen NL, Goldstein SL, Frøslev T, Christiansen CF, Olsen M (2017) Cardiac surgery in patients with congenital heart disease is associated with acute kidney injury and the risk of chronic kidney disease. Kidney Int 92:751–756. https://doi.org/10.1016/j.kint.2017.02.021

    Article  Google Scholar 

  4. Uber AM, Sutherland SM (2020) Acute kidney injury in hospitalized children: consequences and outcomes. Pediatr Nephrol 35:213–220. https://doi.org/10.1007/s00467-018-4128-7

    Article  Google Scholar 

  5. Sawhney S, Marks A, Fluck N, Levin A, McLernon D, Prescott G, Black C (2017) Post-discharge kidney function is associated with subsequent ten-year renal progression risk among survivors of acute kidney injury. Kidney Int 92:440–452. https://doi.org/10.1016/j.kint.2017.02.019

    Article  Google Scholar 

  6. 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. https://doi.org/10.2215/CJN.09350817

    Article  Google Scholar 

  7. Stads S, Fortrie G, van Bommel J, Zietse R, Betjes MG (2013) Impaired kidney function at hospital discharge and long-term renal and overall survival in patients who received CRRT. Clin J Am Soc Nephrol 8:1284–1291. https://doi.org/10.2215/CJN.06650712

    Article  Google Scholar 

  8. 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. https://doi.org/10.1016/j.jpeds.2014.04.058

    Article  CAS  Google Scholar 

  9. Mammen C, Al Abbas A, Skippen P, Nadel H, Levine D, Collet JP, Matsell D (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. https://doi.org/10.1053/j.ajkd.2011.10.048

    Article  Google Scholar 

  10. 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. https://doi.org/10.1038/sj.ki.5000032

    Article  CAS  Google Scholar 

  11. Greenberg JH, Zappitelli M, Devarajan P, Thiessen-Philbrook HR, Krawczeski C, Li S, Garg AX, Coca S, Parikh CR, TRIBE-AKI Consortium (2016) Kidney outcomes 5 years after pediatric cardiac surgery: the TRIBE-AKI study. JAMA Pediatr 170:1071–1078. https://doi.org/10.1001/jamapediatrics.2016.1532

    Article  Google Scholar 

  12. Sutherland SM, Goldstein SL, Alexander SR (2014) The prospective pediatric continuous renal replacement therapy (ppCRRT) registry: a critical appraisal. Pediatr Nephrol 29:2069–2076. https://doi.org/10.1007/s00467-013-2594-5

    Article  Google Scholar 

  13. Chawla LS, Amdur RL, Amodeo S, Kimmel PL, Palant CE (2011) The severity of acute kidney injury predicts progression to chronic kidney disease. Kidney Int 79:1361–1369. https://doi.org/10.1038/ki.2011.42

    Article  Google Scholar 

  14. Holmes J, Roberts G, May K, Tyerman K, Geen J, Williams JD, Phillips AO, Welsh AKI Steering Group (2017) The incidence of pediatric acute kidney injury is increased when identified by a change in a creatinine-based electronic alert. Kidney Int 92:432–439. https://doi.org/10.1016/j.kint.2017.03.009

    Article  Google Scholar 

  15. Schwartz GJ, Work DF (2009) Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol 4:1832–1843. https://doi.org/10.2215/CJN.01640309

    Article  Google Scholar 

  16. Zappitelli M, Parikh CR, Akcan-Arikan A, Washburn KK, Moffett BS, Goldstein SL (2008) Ascertainment and epidemiology of acute kidney injury varies with definition interpretation. Clin J Am Soc Nephrol 3:948–954. https://doi.org/10.2215/CJN.05431207

    Article  Google Scholar 

  17. Lo LJ, Go AS, Chertow GM, McCulloch CE, Fan D, Ordoñez JD, Hsu CY (2009) Dialysis-requiring acute renal failure increases the risk of progressive chronic kidney disease. Kidney Int 7:893–899. https://doi.org/10.1038/ki.2009.289

    Article  CAS  Google Scholar 

  18. Basu B, Mahapatra TK, Roy B, Schaefer F (2016) Efficacy and outcomes of continuous peritoneal dialysis versus daily intermittent hemodialysis in pediatric acute kidney injury. Pediatr Nephrol 3:1681–1689. https://doi.org/10.1007/s00467-016-3412-7

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E Chicago Ave, Chicago, IL, 60611, USA

    Jeanne Frisby-Zedan, Matthew F. Barhight, Mahima Keswani & Delphine Nelson

  2. Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Jeanne Frisby-Zedan, Matthew F. Barhight, Mahima Keswani, Jennifer Arzu & Delphine Nelson

Authors
  1. Jeanne Frisby-Zedan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthew F. Barhight
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mahima Keswani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jennifer Arzu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Delphine Nelson
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: JF, DN; methodology: JF, DN; data curation: MK, DN; investigation: JF; formal analysis and validation: JA; writing — original draft preparation: JF; writing — review and editing: JF, DN, MB, MK, JA; supervision: DN.

Corresponding author

Correspondence to Jeanne Frisby-Zedan.

Ethics declarations

Ethics approval

This study was approved as exempt status by the Ann & Robert H. Lurie Children’s Hospital of Chicago Institutional Review Board (IRB 2019–2746) due to the research study posing minimal risk to study participants and involving only information collection and analysis of identifiable health information when that use is regulated under the HIPAA Privacy Rule for the purposes of “health care operations” or “research.” The study was conducted in accordance with the Declaration of Helsinki.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

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.

Graphical Abstract (PPTX 76.2 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Frisby-Zedan, J., Barhight, M.F., Keswani, M. et al. Long-term kidney outcomes in children following continuous kidney replacement therapy. Pediatr Nephrol 38, 565–572 (2023). https://doi.org/10.1007/s00467-022-05579-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-022-05579-1

Keywords

Search

Navigation