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

IF 2.6 3区医学 Q1 PEDIATRICS

Pediatric Nephrology Pub Date : 2025-10-01 Epub Date: 2025-05-21 DOI:10.1007/s00467-025-06810-5

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

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引用次数: 0

Abstract

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.

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急性肾损伤进展为慢性肾脏疾病：一项前瞻性队列研究

背景：低收入和中等收入国家（LMIC）对急性肾损伤（AKI）重症儿童肾脏结局的前瞻性研究很少。我们进行了一项初步研究，以评估短暂性aki -持续性aki -急性肾脏疾病（AKD）和慢性肾脏疾病（CKD）的连续性。方法：在2021年1月至2022年6月期间，我们的三级儿科重症监护室（PICU）收治的1-18岁儿童（无已知的肾脏合并症）发展为AKI，并在AKI发病后1个月和3个月进行随访。AKI和CKD的定义依据KDIGO 2012。蛋白尿、高血压、估计肾小球滤过率（eGFR） 60- 90ml /kg/1.73 m2或高滤过（eGFR≥150ml /kg/1.73 m2）定义CKD的风险。结果：390名儿童中，15% （n = 57）发生AKI。75% （n = 43）的AKI患者有潜在的主要非肾脏全身性病因。入院后中位5天（IQR 4-7）死亡14例（25%），出院后失访3例。在有3个月数据的40名AKI幸存者中，短暂性AKI发生率为40% (n = 16)，持续性AKI发生率为20% (n = 8)， AKD发生率为32% (n = 13)， CKD发生率为8% （n = 3）。此外，18% （n = 7）有CKD的风险。结论：在这项LMIC研究中，PICU AKI幸存者3个月时肾脏后遗症较高。该试验支持在低收入和中等收入国家进行更大规模前瞻性试验的必要性和可行性，以了解所有AKI儿童的结局。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Nephrology 医学-泌尿学与肾脏学

CiteScore

4.70

自引率

20.00%

发文量

465

审稿时长

1 months

期刊介绍： International Pediatric Nephrology Association Pediatric Nephrology publishes original clinical research related to acute and chronic diseases that affect renal function, blood pressure, and fluid and electrolyte disorders in children. Studies may involve medical, surgical, nutritional, physiologic, biochemical, genetic, pathologic or immunologic aspects of disease, imaging techniques or consequences of acute or chronic kidney disease. There are 12 issues per year that contain Editorial Commentaries, Reviews, Educational Reviews, Original Articles, Brief Reports, Rapid Communications, Clinical Quizzes, and Letters to the Editors.