Paediatric AKI survivors at elevated risk of late adverse outcomes

Acute kidney injury (AKI) in children is associated with increased long-term risks of adverse outcomes such as chronic kidney disease (CKD) and mortality, according to a systematic review and meta-analysis.

Researchers searched multiple online databases for studies in which long-term outcomes (ie, CKD, mortality, hypertension, or proteinuria) in survivors of paediatric AKI were examined. Studies involving children with pre-existing CKD, solid organ transplants, hepatorenal or cardiorenal syndromes, obstructive uropathy, or AKI due to vascular aetiology (such as hemolytic uremic syndrome) were excluded.

A total of 39 studies involving 16,151 participants met the eligibility criteria and were included in the meta-analysis. Of the studies, 14 included children with AKI in paediatric intensive care setting, and eight involved neonatal AKI. AKI was defined according to the KDIGO criteria in 28 studies.

Pooled data showed that following AKI, CKD occurred in 17 percent of participants (95 percent confidence interval [CI], 12–22), death in 6 percent (95 percent CI, 3–8), proteinuria in 20 percent (95 percent CI, 12–29), and hypertension in 16 percent (95 percent CI, 11–23).

In 23 studies with non-AKI comparators and follow-up ranging 3 months to 18 years, AKI was associated with greater odds of CKD (OR, 1.74, 95 percent CI, 1.02–2.95) and mortality (OR, 1.92, 95 percent CI, 1.35–2.75) but not proteinuria (OR, 1.18, 95 percent CI, 0.62–2.25) or hypertension (OR, 1.29, 95 percent CI, 0.72–2.31).

Notably, the odds of CKD were higher among individuals with greater AKI severity (stages 2-3: OR, 2.84, 95 percent CI, 1.49–4.15; stage 1: OR, 1.72, 95 percent CI, 1.11–2.67).

The findings underscore the need for structured post-AKI follow-up.