Long-term Risk of CKD in Children Surviving Episodes of Acute Kidney Injury in the Intensive Care Unit: A Prospective Cohort Study
Long-term Risk of CKD in Children Surviving Episodes of Acute Kidney Injury in the Intensive Care Unit: A Prospective Cohort Study
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DOI：
10.1053/j.ajkd.2011.10.048
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发表时间：
2012-04-01
影响因子：
13.2
通讯作者：
Matsell, Douglas G.
中科院分区：
文献类型：
--
作者：
Mammen, Cherry;Al Abbas, Abdullah;Matsell, Douglas G.
背景资料：标准化急性肾损伤（AKI）定义的发展使人们能够更好地了解AKI流行病学，但儿科重症监护环境中AKI的长期肾脏结局尚未得到很好的确定。本研究旨在：（1）确定在三级护理儿科重症监护病房（ICU）中发生AKI后1 - 3年的儿童中慢性肾脏病（CKD）的发病率，（2）确定有CKD风险的患者比例，（3）比较有和无CKD患者的ICU入院特征。设计：前瞻性队列研究。根据AKI网络（AKIN）标准，2006 - 2008年入住不列颠哥伦比亚省儿童医院儿科ICU的AKI患者。在AKI后1年、2年或3年对存活患者（大多数AKI患者短期恢复）进行评估。预测因素：根据AKIN定义的AKI严重程度和几个ICU入院特征，包括人口统计学、诊断、疾病严重程度和通气数据。CKD定义为存在蛋白尿和/或肾小球滤过率（GFR）= 150 mL/min/1.73 m2）。AKI 1、2和3期患者的比例分别为44/126（35%）、47/126（37%）和35/126（28%）。AKI后1 - 3年的CKD患者数量为13/126（总体10.3%; 2/44 [4.5%]为1期，5/47 [10.6%]为2期，6/35 [17.1%]为3期; P = 0.2）。此外，126例患者中有59例（46.8%）被确定为有CKD风险。局限性：几例AKI患者失访，可能低估了CKD的发病率。结论：在三级护理儿科ICU患者中，AKI后1 - 3年约有10%发生CKD。随着进一步随访，该人群的CKD负担可能更高，因为几例患者被确定为存在CKD风险。无论AKI的严重程度如何，所有儿科ICU患者都应定期监测长期肾损伤。美国肾脏病杂志59（4）：523 - 530。皇冠版权所有（C）2012由Elsevier Inc.发布。代表国家肾脏基金会All rights reserved.
Background: The development of standardized acute kidney injury (AKI) definitions has allowed for a better understanding of AKI epidemiology, but the long-term renal outcomes of AKI in the pediatric critical care setting have not been well established. This study was designed to: (1) determine the incidence of chronic kidney disease (CKD) in children 1-3 years after an episode of AKI at a tertiary-care pediatric intensive care unit (ICU), (2) identify the proportion of patients at risk of CKD, and (3) compare ICU admission characteristics in those with and without CKD.Design: Prospective cohort study.Setting & Participants: Patients admitted to the British Columbia Children's Hospital pediatric ICU from 2006-2008 with AKI, as defined by AKI Network (AKIN) criteria. Surviving patients, most with short-term recovery from their AKI, were assessed at 1, 2, or 3 years after AKI.Predictors: Severity of AKI as defined by AKIN and several ICU admission characteristics, including demographics, diagnosis, severity of illness, and ventilation data.Outcomes & Measurements: CKD was defined as the presence of albuminuria and/or glomerular filtration rate (GFR) = 150 mL/min/1.73 m(2)).Results: The proportion of patients with AKI stages 1, 2, and 3 were 44 of 126 (35%), 47 of 126 (37%), and 35 of 126 (28%), respectively. The number of patients with CKD 1-3 years after AKI was 13 of 126 (10.3% overall; 2 of 44 [4.5%] with stage 1, 5 of 47 [10.6%] with stage 2, and 6 of 35 [17.1%] with stage 3; P = 0.2). In addition, 59 of 126 (46.8%) patients were identified as being at risk of CKD.Limitations: Several patients identified with AKI were lost to follow-up, with the potential of underestimating the incidence of CKD.Conclusions: In tertiary-care pediatric ICU patients, similar to 10% develop CKD 1-3 years after AKI. The burden of CKD in this population may be higher with further follow-up because several patients were identified as being at risk of CKD. Regardless of the severity of AKI, all pediatric ICU patients should be monitored regularly for long-term kidney damage. Am J Kidney Dis. 59(4):523-530. Crown Copyright (C) 2012 Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. All rights reserved.