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Background <p>Prospective studies on kidney outcomes in critically ill children with acute kidney injury (AKI) are scarce from low- and middle-income countries (LMIC). We conducted a pilot study to evaluate the continuum of transient AKI—persistent AKI—acute kidney disease (AKD) and chronic kidney disease (CKD).</p> Methods <p>Children (1–18&#xa0;years) admitted to our tertiary Pediatric Intensive Care Unit (PICU) and developing AKI with no known pre-existing kidney co-morbidities from January 2021 to June 2022 were included with follow up visits at 1 and 3&#xa0;months after AKI onset. AKI and CKD were defined as per KDIGO 2012. At risk of CKD was defined by albuminuria, hypertension, estimated glomerular filtration rate (eGFR) 60–90&#xa0;ml/kg/1.73 m<sup>2</sup> or hyperfiltration (eGFR ≥ 150&#xa0;ml/kg/1.73 m<sup>2</sup>).</p> Results <p>Of 390 children, 15% (<i>n</i> = 57) developed AKI. 75% (<i>n</i> = 43) with AKI had underlying primarily non-kidney systemic etiology. Fourteen (25%) died at median 5&#xa0;days (IQR 4–7) after admission, and three were lost to follow up after discharge. For the 40 AKI survivors with three months data, incidence of transient AKI was 40% (<i>n</i> = 16), persistent AKI 20% (<i>n</i> = 8), AKD 32% (<i>n</i> = 13), and CKD 8% (<i>n</i> = 3). In addition, 18% (<i>n</i> = 7) were at risk of CKD. 38% with AKI for &gt; 48&#xa0;h vs. 6% with AKI &lt; 48&#xa0;h developed CKD or were at risk of CKD (<i>p</i> = 0.025). All three AKI survivors who progressed to CKD had an underlying primarily kidney etiology and progressed from AKD to CKD.</p> Conclusions <p>In this LMIC study, kidney sequelae were high at 3&#xa0;months among PICU AKI survivors. This pilot supports the need and feasibility of larger prospective trials in LMIC settings to understand outcomes for all children with AKI.</p> Graphical abstract <p></p>

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Progression of acute kidney injury to chronic kidney disease: a prospective cohort study

  • 期刊论文

  • 发表日期：

    2025年5月21日

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  • Shreyashi Karmakar,
  • Deblina Dasgupta,
  • Shakil Akhtar,
  • Sanjukta Poddar,
  • Prabhas Prasun Giri,
  • Yincent Tse,
  • Rajiv Sinha

摘要

Background

Prospective studies on kidney outcomes in critically ill children with acute kidney injury (AKI) are scarce from low- and middle-income countries (LMIC). We conducted a pilot study to evaluate the continuum of transient AKI—persistent AKI—acute kidney disease (AKD) and chronic kidney disease (CKD).

Methods

Children (1–18 years) admitted to our tertiary Pediatric Intensive Care Unit (PICU) and developing AKI with no known pre-existing kidney co-morbidities from January 2021 to June 2022 were included with follow up visits at 1 and 3 months after AKI onset. AKI and CKD were defined as per KDIGO 2012. At risk of CKD was defined by albuminuria, hypertension, estimated glomerular filtration rate (eGFR) 60–90 ml/kg/1.73 m2 or hyperfiltration (eGFR ≥ 150 ml/kg/1.73 m2).

Results

Of 390 children, 15% (n = 57) developed AKI. 75% (n = 43) with AKI had underlying primarily non-kidney systemic etiology. Fourteen (25%) died at median 5 days (IQR 4–7) after admission, and three were lost to follow up after discharge. For the 40 AKI survivors with three months data, incidence of transient AKI was 40% (n = 16), persistent AKI 20% (n = 8), AKD 32% (n = 13), and CKD 8% (n = 3). In addition, 18% (n = 7) were at risk of CKD. 38% with AKI for > 48 h vs. 6% with AKI < 48 h developed CKD or were at risk of CKD (p = 0.025). All three AKI survivors who progressed to CKD had an underlying primarily kidney etiology and progressed from AKD to CKD.

Conclusions

In this LMIC study, kidney sequelae were high at 3 months among PICU AKI survivors. This pilot supports the need and feasibility of larger prospective trials in LMIC settings to understand outcomes for all children with AKI.

Graphical abstract