Catherine Morgan, Emma Forest, Emma Ulrich, Scott Sutherland
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引用次数: 0
摘要
急性肾损伤(AKI)是一个重大的全球性健康问题,管理成本高昂,其与负面儿科健康结果之间的联系已得到明确证实。当我们利用以往的流行病学信息来推进研究和护理模式时,需要考虑的一个最基本的问题就是小儿急性肾损伤与健康结果之间的因果关系的强度。在这篇综述中,我们运用布拉德福德-希尔标准的基础框架来评估 AKI 与儿童相关不良后果之间的因果联系程度。现有的儿童数据支持 AKI 与包括死亡率、住院时间和通气时间在内的短期结果之间存在因果关系。要明确长期关联的因果关系,需要在儿童中开展更多高质量的观察研究,仔细考虑如何定义小儿 AKI 后最有意义、最可测量的长期结果,并整合与疾病机制相关的不断发展的生物数据。预防或减轻 AKI 应能改善预后。证明这种可逆性将巩固对因果关系的信心,改善儿童健康,并突出与临床医生、科学家和政策制定者高度相关的一个方面。
Pediatric acute kidney injury and adverse health outcomes: using a foundational framework to evaluate a causal link.
Acute kidney injury (AKI) is a major global health problem, expensive to manage, and its associations with negative pediatric health outcomes have been clearly demonstrated. One of the most fundamental questions to consider as we use previous epidemiological information to advance research and care paradigms is the strength of the causal link between pediatric AKI and health outcomes. In this review, we apply the foundational framework of the Bradford Hill criteria to evaluate the extent to which a causal link exists between AKI and the associated adverse outcomes in children. Available data in children support a causal link between AKI and short-term outcomes including mortality, length of stay, and ventilation time. Clarifying the causal nature of longer term associations requires further high-quality observational studies in children, careful consideration of what defines the most meaningful and measurable longer term outcomes after pediatric AKI, and integration of evolving biological data related to mechanisms of disease. Preventing or mitigating AKI should lead to improved outcomes. Demonstrating such reversibility will solidify confidence in the causal relationship, improve child health, and highlight an aspect which is highly relevant to clinicians, scientists, and policy makers.
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.