Long Term Renal Outcomes in Survivors of Acute Kidney Injury in Critically-Ill Children and Neonates

Abstract

The epidemiology of pediatric acute kidney injury (pAKI) has transformed in the last decades with a shift from primary kidney disease to AKI associated with systemic illnesses or their treatments in critically-ill children and neonates. Even though pAKI has been shown to be associated with poor short-term outcomes including mortality in multiple studies, the long-term renal outcomes in survivors of pAKI in the pediatric and neonatal intensive care unit (PICU/NICU) settings have been understudied. The purpose of this article was to explore the burden of chronic kidney disease (CKD) in survivors of pAKI in critically-ill children and neonates through a review of the literature. We identified 10 observational studies from PICU (n=7) and NICU (n=3) survivors revealing a high prevalence of CKD following AKI (PICU:10-69%, NICU:63-85%). The wide range of CKD prevalence is likely related to multiple sources of heterogeneity between studies including definitions of AKI and CKD, varying lengths of follow-up, and large attrition rates. In light of the large number of patients identified with CKD following pAKI, we suggest that all critically-ill children and neonates should have ongoing surveillance after an AKI episode.