Department of Pediatrics, Division of Nephrology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Québec, Canada.
Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Pediatr Nephrol. 2020 Jun;35(6):1097-1107. doi: 10.1007/s00467-020-04488-5. Epub 2020 Mar 11.
To develop a pediatric-specific hypertension algorithm using administrative data and use it to evaluate the association between acute kidney injury (AKI) in the intensive care unit (ICU) and hypertension diagnosis 5 years post-discharge.
Two-center retrospective cohort study of children (≤ 18 years old) admitted to the pediatric ICU in Montreal, Canada, between 2003 and 2005 and followed until 2010. Patients with a valid healthcare number and without end-stage renal disease were included. Patients who could not be merged with the provincial database, did not survive admission, underwent cardiac surgery, had pre-existing renal disease associated with hypertension or a prior diagnosis of hypertension were excluded. AKI defined using the Kidney Disease: Improving Global Outcomes (KDIGO) definition. Using diagnostic codes and medications from administrative data, novel pediatric-specific hypertension definitions were designed. Both the evaluation of the prevalence of hypertension diagnosis and the association between AKI and hypertension occurred.
Nineteen hundred and seventy eight patients were included (median age at admission [interquartile range] 4.3 years [1.1-11.8], 44% female, 325 (16.4%) developed AKI). Of these patients, 130 (7%) had a hypertension diagnosis 5 years after discharge. Patients with AKI had a higher prevalence of hypertension diagnosis [non-AKI: 84/1653 (5.1%) vs. AKI: 46/325 (14.2%), p < .001]. Children with AKI had a higher adjusted risk of hypertension diagnosis (hazard ratio [95% confidence interval] 2.19 [1.47-3.26]).
Children admitted to the ICU have a high prevalence of hypertension post-discharge and children with AKI have over two times higher risk of hypertension compared to those with no AKI.
利用行政数据开发儿科专用高血压算法，并利用该算法评估儿童重症监护病房（ICU）中急性肾损伤（AKI）与出院后 5 年内高血压诊断之间的关系。
这是一项在加拿大蒙特利尔的儿科 ICU 接受治疗的儿童（≤18 岁）进行的两中心回顾性队列研究，研究时间为 2003 年至 2005 年，随访至 2010 年。纳入标准为患者具有有效的医疗保健号码且无终末期肾病。排除标准为无法与省级数据库合并、入院期间未存活、接受心脏手术、存在与高血压相关的预先存在的肾脏疾病或先前诊断为高血压的患者。采用肾脏病：改善全球预后（KDIGO）定义来定义 AKI。利用行政数据中的诊断代码和药物，设计了新的儿科专用高血压定义。评估高血压诊断的患病率以及 AKI 与高血压之间的关系。
共纳入 1978 例患者（入院时的中位年龄[四分位数范围]为 4.3 岁[1.1-11.8]，44%为女性，325 例[16.4%]发生 AKI）。这些患者中有 130 例（7%）在出院后 5 年内被诊断为高血压。发生 AKI 的患者高血压诊断的患病率更高[非 AKI：1653 例中的 84 例（5.1%） vs. AKI：325 例中的 46 例（14.2%），p<0.001]。AKI 患儿发生高血压诊断的风险更高（调整后的危险比[95%置信区间]为 2.19[1.47-3.26]）。
入住 ICU 的儿童出院后高血压的患病率较高，与无 AKI 的患者相比，发生 AKI 的儿童发生高血压的风险高 2 倍以上。
