Researchers: Monitor Pediatric AKI Patients for CKD

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Pediatric patients admitted to an intensive care unit (ICU) for acute kidney injury (AKI) should be monitored regularly for long-term kidney damage, researchers concluded.

In a prospective study of 126 patients admitted to the British Columbia Children's Hospital pediatric ICU with AKI from 2006 to 2008, Cherry Mammen, MD, MHSc, and colleagues found that chronic kidney disease (CKD) developed in just over 10% of subjects one to three years later, according to an online report in the American Journal of Kidney Diseases. The researchers noted that the burden of CKD in this population may be even higher with longer follow-up because a significant number of patients were identified as being at risk for CKD.

The investigators defined CKD as the presence of albuminuria and/or a glomerular filtration rate (GFR) below 60 mL/min/1.73 m2. Patients at risk for CKD included those who had a mildly decreased GFR (60-90 mL/min/1.73 m2), hypertension, and/or hyperfiltration (GFR greater than 150 mL/min/1.73 m2).

CKD developed in 13 (10.3%) of the 126 patients, and researchers identified 59 subjects (46.8%) as being at risk for CKD.

Dr. Mammen and his colleagues defined AKI according to AKI Network criteria: abrupt (within 48 hours) decrease in kidney function with an absolute increase in serum creatinine level of 0.3 mg/L or greater, a percentage increase in serum creatinine level greater than 50% (1.5-fold from baseline), or a decrease in urine output (less than 0.5 mL/kg/hour for more than six hours.

“In light of the large number of patients identified with renal sequelae after AKI, we suggest that all critically ill children should be screened for signs of kidney disease after an episode of AKI regardless of the severity or cause,” Dr. Mammen's team concluded.

As early CKD often is clinically silent, with proteinuria and hypertension being two treatable complications of kidney disease, “all children should undergo regular urinalyses and blood pressure assessments at least annually for several years after AKI.”

The researchers stated that their results overall “are generalizable to large tertiary-care pediatric ICU centers with similar populations, including postoperative cardiac surgery patients, which made up approximately half the cohort and half our cases of CKD.”

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