Long-term risk of chronic kidney disease and mortality in children after acute kidney injury: a systematic review

BMC Nephrol. 2014 Nov 21;15:184. doi: 10.1186/1471-2369-15-184.

Abstract

Background: Acute kidney injury (AKI) is associated with significant short-term morbidity and mortality in children. However, the risk for long-term outcomes after AKI is largely unknown.

Methods: We performed a systematic review and meta-analysis to determine the cumulative incidence rate of proteinuria, hypertension, decline in glomerular filtration rate (GFR), and mortality after an episode of AKI. After screening 1934 published articles from 1985-2013, we included 10 cohort studies that reported long-term outcomes after AKI in children.

Results: A total of 346 patients were included in these studies with a mean follow-up of 6.5 years (range 2-16) after AKI. The studies were of variable quality and had differing definitions of AKI with five studies only including patients who required dialysis during an AKI episode. There was a substantial discrepancy in the outcomes across these studies, most likely due to study size, disparate outcome definitions, and methodological differences. In addition, there was no non-AKI comparator group in any of the published studies. The cumulative incidence rates for proteinuria, hypertension, abnormal GFR (<90 ml/min/1.73 m2), GFR < 60 ml/min/1.73 m2, end stage renal disease, and mortality per 100 patient-years were 3.1 (95% CI 2.1-4.1), 1.4 (0.9-2.1), 6.3 (5.1-7.5), 0.8 (0.4 -1.4), 0.9 (0.6-1.4), and 3.7 (2.8-4.5) respectively.

Conclusions: AKI appears to be associated with a high risk of long-term renal outcomes in children. These findings may have implications for care after an episode of AKI in children. Future prospective studies with appropriate non-AKI comparator groups will be required to confirm these results.

Publication types

  • Research Support, N.I.H., Extramural
  • Review
  • Systematic Review

MeSH terms

  • Acute Kidney Injury / complications*
  • Adolescent
  • Age Distribution
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension / epidemiology
  • Hypertension / etiology
  • Incidence
  • Infant
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / etiology
  • Male
  • Prospective Studies
  • Proteinuria / epidemiology
  • Proteinuria / etiology
  • Renal Insufficiency, Chronic / etiology
  • Renal Insufficiency, Chronic / mortality*
  • Risk Assessment
  • Treatment Outcome