Acute Kidney Injury in Critically III Children and Subsequent Chronic Kidney Disease
Acute Kidney Injury in Critically III Children and Subsequent Chronic Kidney Disease
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DOI：
10.1177/2054358119880188
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发表时间：
2019-01-01
影响因子：
1.7
通讯作者：
Zappitelli, Michael
中科院分区：
文献类型：
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作者：
Hessey, Erin;Perreault, Sylvie;Zappitelli, Michael
背景资料：从急性肾损伤（阿基）到慢性肾脏病（CKD）的进展在儿童中尚不清楚。目的：我们旨在使用管理数据制定儿科CKD定义，并使用它来评估危重儿童阿基与出院后5年CKD之间的关联。设计：使用图表收集和管理数据的回顾性队列研究。设置：在加拿大蒙特利尔进行的双中心研究。患者：儿童（= I CKD诊断代码或>= I CKD特定药物处方。方法：用于定义暴露（阿基）的图表数据与用于定义结局（CKD）的省级行政数据合并。考克斯回归被用来评估AKI-CKD association.Results：共2235例（56%男性）患者被纳入，平均入院年龄为3.7岁。共有464例（21%）患者在儿科ICU住院期间发生阿基。出院后5年，43例（2%）患者诊断为CKD。同时患有1期和2-3阿基的患者诊断为CKD的风险增加，调整后的风险比（95%置信区间）分别为2.2（1.1-4.5）和2.5（1.1-5.7）（P <0.001）。局限性：结果可能无法推广到非ICU患者。我们无法控制出院后的变量，未来的研究应该尝试探索这些额外的潜在危险因素further.Conclusions：急性肾损伤与5年出院后CKD诊断由行政卫生保健数据定义。
Background: The progression from acute kidney injury (AKI) to chronic kidney disease (CKD) is not well understood in children.Objectives: We aimed to develop a pediatric CKD definition using administrative data and use it to evaluate the association between AKI in critically ill children and CKD 5 years after hospital discharge.Design: Retrospective cohort study using chart collection and administrative data.Setting: Two-center study in Montreal, Canada.Patients: Children (= I CKD diagnostic code or >= I CKD-specific medication prescription.Methods: Chart data used to define the exposure (AKI) were merged with provincial administrative data used to define the outcome (CKD). Cox regression was used to evaluate the AKI-CKD association.Results: A total of 2235 (56% male) patients were included, and the median admission age was 3.7 years. A total of 464 (21%) patients developed AKI during pediatric ICU admission. At 5 years post-discharge, 43 (2%) patients had a CKD diagnosis. Patients with both stage 1 and stage 2-3 AKI had increased risk of a CKD diagnosis, with the adjusted hazard ratios (95% confidence intervals) of 2.2 (1.1-4.5) and 2.5 (1.1-5.7), respectively (P < .001).Limitations: Results may not be generalizable to non-ICU patients. We were not able to control for post-discharge variables; future research should try to explore these additional potential risk factors further.Conclusions: Acute kidney injury is associated with 5-year post-discharge CKD diagnosis defined by administrative health care data.