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

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

Author information

1
Department of Internal Medicine, Section of Nephrology, New Haven, CT and VA Medical Center, Yale University School of Medicine, West Haven, CT, USA. chirag.parikh@yale.edu.

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.

PMID:
25416588
PMCID:
PMC4251927
DOI:
10.1186/1471-2369-15-184
[Indexed for MEDLINE]
Free PMC Article
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