Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada.
Faculty of Medicine, McGill University, Montreal, QC, Canada.
Pediatr Crit Care Med. 2021 Apr 1;22(4):412-425. doi: 10.1097/PCC.0000000000002662.
It is unknown whether children with acute kidney injury during PICU admission have kidney function monitored after discharge. Objectives: 1) describe postdischarge serum creatinine monitoring after PICU acute kidney injury and 2) determine factors associated with postdischarge serum creatinine monitoring.
Secondary analysis of longitudinal cohort study data.
Two PICUs in Montreal and Edmonton, Canada.
Children (0-18 yr old) surviving PICU admission greater than or equal to 2 days from 2005 to 2011. Exclusions: postcardiac surgery and prior kidney disease. Exposure: acute kidney injury by Kidney Disease: Improving Global Outcomes serum creatinine definition.
None.
Primary outcome: postdischarge serum creatinine measured by 90 days, 1 year, and 5-7 years.
Healthcare events and nephrology follow-up.
Proportions with outcomes; logistic regression to evaluate factors associated with the primary outcome. Kaplan-Meier analysis of time to serum creatinine measurement and healthcare events.
Of n = 277, 69 (25%) had acute kidney injury; 29/69 (42%), 34/69 (49%), and 51/69 (74%) had serum creatinine measured by 90 days, 1 year, and 5-7 year postdischarge, respectively. Acute kidney injury survivors were more likely to have serum creatinine measured versus nonacute kidney injury survivors at all time points (p ≤ 0.01). Factors associated with 90-day serum creatinine measurement were inpatient nephrology consultation (unadjusted odds ratio [95% CI], 14.9 [1.7-127.0]), stage 2-3 acute kidney injury (adjusted odds ratio, 3.4 [1.1-10.2]), and oncologic admission diagnosis (adjusted odds ratio, 10.0 [1.1-93.5]). A higher proportion of acute kidney injury versus nonacute kidney injury survivors were readmitted by 90 days (25 [36%] vs 44 [21%]; p = 0.01) and 1 year (33 [38%] vs 70 [34%]; p = 0.04). Of 24 acute kidney injury survivors diagnosed with chronic kidney disease or hypertension at 5-7 year follow-up, 16 (67%) had serum creatinine measurement and three (13%) had nephrology follow-up postdischarge.
Half of PICU acute kidney injury survivors have serum creatinine measured within 1-year postdischarge and follow-up is suboptimal for children developing long-term kidney sequelae. Knowledge translation strategies should emphasize the importance of serum creatinine monitoring after childhood acute kidney injury.
目前尚不清楚入住儿科重症监护病房（PICU）期间发生急性肾损伤的儿童在出院后是否进行了肾功能监测。目的：1）描述 PICU 急性肾损伤患儿出院后血清肌酐监测情况，2）确定与出院后血清肌酐监测相关的因素。
对纵向队列研究数据的二次分析。
加拿大蒙特利尔和埃德蒙顿的 2 个 PICU。
2005 年至 2011 年期间入住 PICU 2 天或以上的存活患儿（0-18 岁）。排除标准：心脏手术后和既往肾脏疾病。暴露因素：急性肾损伤符合改善全球肾脏病预后组织血清肌酐定义。
无。
主要结局指标：出院后 90 天、1 年和 5-7 年时测量的血清肌酐。次要结局指标：医疗保健事件和肾脏科随访。
结局指标的比例；logistic 回归分析评估与主要结局相关的因素。Kaplan-Meier 分析血清肌酐测量时间和医疗保健事件。
在 n = 277 例患儿中，69 例（25%）发生急性肾损伤；29/69（42%）、34/69（49%）和 51/69（74%）分别在出院后 90 天、1 年和 5-7 年时测量到血清肌酐。与非急性肾损伤幸存者相比，急性肾损伤幸存者在所有时间点更有可能测量血清肌酐（p≤0.01）。与 90 天内测量血清肌酐相关的因素包括住院肾脏科会诊（未调整比值比[95%CI]，14.9[1.7-127.0]）、2-3 期急性肾损伤（调整比值比，3.4[1.1-10.2]）和肿瘤住院诊断（调整比值比，10.0[1.1-93.5]）。与非急性肾损伤幸存者相比，急性肾损伤幸存者在 90 天（25[36%] vs 44[21%]；p = 0.01）和 1 年（33[38%] vs 70[34%]；p = 0.04）时更有可能再次入院。在 5-7 年随访时，24 例急性肾损伤幸存者中诊断为慢性肾脏病或高血压的患儿中，16 例（67%）测量了血清肌酐，3 例（13%）出院后进行了肾脏科随访。
一半的 PICU 急性肾损伤幸存者在出院后 1 年内测量了血清肌酐，儿童的长期肾脏后遗症随访情况并不理想。知识转化策略应强调儿童急性肾损伤后监测血清肌酐的重要性。
