Kidney and blood pressure abnormalities 6 years after acute kidney injury in critically ill children: a prospective cohort study

Background Acute kidney injury (AKI) in pediatric intensive care unit (PICU) children may be associated with long-term chronic kidney disease or hypertension. Objectives: To estimate (1) prevalence of kidney abnormalities (low estimated glomerular filtration rate (eGFR) or albuminuria) and blood pre...

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Bibliographic Details
Published in:Pediatric research 2020-08, Vol.88 (2), p.271-278
Main Authors: Benisty, Kelly, Morgan, Catherine, Hessey, Erin, Huynh, Louis, Joffe, Ari R., Garros, Daniel, Dancea, Adrian, Sauve, Reginald, Palijan, Ana, Pizzi, Michael, Bhattacharya, Sudeshna, Doucet, Julie Ann, Cockovski, Vedran, Gottesman, Ronald G., Goldstein, Stuart L., Zappitelli, Michael
Format: Article
Language:English
Subjects:
Blood pressure
Clinical Research Article
Cohort analysis
Creatinine
Hypertension
Kidneys
Medicine
Medicine & Public Health
Pediatric Surgery
Pediatrics
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Summary:Background Acute kidney injury (AKI) in pediatric intensive care unit (PICU) children may be associated with long-term chronic kidney disease or hypertension. Objectives: To estimate (1) prevalence of kidney abnormalities (low estimated glomerular filtration rate (eGFR) or albuminuria) and blood pressure (BP) consistent with pre-hypertension or hypertension, 6 years after PICU admission; (2) if AKI is associated with these outcomes. Methods Longitudinal study of children admitted to two Canadian PICUs (January 2005–December 2011). Exposures (retrospective): AKI or stage 2/3 AKI (KDIGO creatinine-based definition) during PICU. Primary outcome (single visit 6 years after admission): presence of (a) low eGFR (30 mg/g) (termed “CKD signs”) or (b) BP consistent with ≥pre-hypertension (≥90th percentile) or hypertension (≥95th percentile). Results Of 277 children, 25% had AKI. AKI and stage 2/3 AKI were associated with 2.2- and 6.6-fold higher adjusted odds, respectively, for the 6-year outcomes. Applying new hypertension guidelines attenuated associations; stage 2/3 AKI was associated with 4.5-fold higher adjusted odds for 6-year CKD signs or ≥elevated BP. Conclusions Kidney and BP abnormalities are common 6 years after PICU admission and associated with AKI. Other risk factors must be elucidated to develop follow-up recommendations and reduce cardiovascular risk.
ISSN:0031-3998
1530-0447
DOI:10.1038/s41390-019-0737-5