Long-term follow-up strategies for children after severe acute kidney injury.

Background: Children experiencing acute kidney injury (AKI) are at heightened risk of developing chronic kidney disease (CKD). While identifying patients at high-risk for CKD after AKI early is crucial, indefinite follow-up may strain healthcare resources. We assessed potential predictive factors for CKD following AKI to guide safe discontinuation of follow-up after one year.

Methods: We evaluated outcomes of children with AKI prospectively. We assessed for associations between hospitalization and first-year outpatient data with presence of estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m² or CKD (eGFR <60 or 60-90 with proteinuria) at 3-5 years after AKI.

Results: 96 patients were included. Patients with eGFR <90 had longer AKI duration, higher prevalence of AKI stage 3, and received more KRT. No patient with CKD at 3-5 years was CKD-free in the first year of follow-up and only three patients with normal eGFR during the first year post-AKI had abnormal eGFR at 3-5 years; all had complex medical diseases which would necessitate kidney function monitoring as standard of care.

Conclusions: Our data suggest patients without eGFR<90/CKD during the first year post-AKI have low CKD risk in the following 2-4 years and may be safely discharged from nephrology clinics after one year of follow-up.

Impact: Patients without eGFR <90/CKD during the first year post-AKI have low CKD risk in the following 2-4 years. Lack of CKD in the first year post-AKI is maintained up to 3-5 years after the original episode. Patients without eGFR <90/CKD in the first year post-AKI can be safely discharged from nephrology care.